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  • 1.
    Adeteg, Sandra
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bergman, Eva-Lena
    Örebro University, School of Health and Medical Sciences.
    Att vara ung vuxen med reumatisk sjukdom och leva med kronisk smärta och trötthet: En kvalitativ intervjustudie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien var att fånga in hur trötthet och smärta påverkar vardagen för unga vuxna med reumatisk sjukdom.

    Metoden är kvalitativ och för datainsamlingen gjordes semistrukturerade intervjuer. Materialet transkriberades transkriberades i sin helt och när det var klart påbörjades analysering av det som framkommit. I analysen sökte vi efter meningsbärande enheter och försökte ordna dem i kategorier och underkategorier.

    Resultatet visar att sjukdomen har en stor påverkan på våra informanters liv, men att de också har bra strategier för att kunna leva med sjukdomen. Det visar också på att även om strategierna är bra och de vet hur de ska hantera sjukdomen så stöter de på hinder, till exempel har skolgången blivit negativt påverkad för de flesta av informanterna. Något som visat sig vara extra viktigt har varit vännerna och det sociala nätverket. Alla informanter har på ett eller annat sätt verkligen understrykt betydelsen av vänner som är förstående och som på det sättet hjälper till att hitta det positiva med livet.

    Slutsatsen som kan dras utifrån detta arbete är att vara ung och ha en reumatisk sjukdom är något som påverkar hela livet. Vi har sett på informanterna i studien att trots detta flyter livet på och de lyckas i de flesta fall att få balans mellan aktivitet och vila. Just denna balans är mycket viktig.

     

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  • 2.
    Ahmed, Sakir
    et al.
    Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, Bhubaneshwar, India.
    Gupta, Latika
    Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
    Kuwana, Masataka
    Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
    Pauling, John D.
    Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, North Bristol NHS Trust, Bristol, UK.
    Day, Jessica
    Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.
    Ravichandran, Naveen
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
    Joshi, Mrudula
    Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sen, Parikshit
    Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, Delhi, 110002, India.
    Jagtap, Kshitij
    Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.
    Nikiphorou, Elena
    Centre for Rheumatic Diseases, King's College London, London, UK; Rheumatology Department, King's College Hospital, London, UK.
    Saha, Sreoshy
    Mymensingh Medical College, Mymensingh, Bangladesh.
    Agarwal, Vishwesh
    Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India.
    Chatterjee, Tulika
    Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
    Lilleker, James B.
    Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.
    Kardes, Sinan
    Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey.
    Milchert, Marcin
    Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, ul Unii Lubelskiej 1, 71-252, Szczecin, Poland.
    Gheita, Tamer
    Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
    Salim, Babur
    Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan.
    Velikova, Tsvetelina
    Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407, Sofia, Bulgaria.
    Gracia-Ramos, Abraham Edgar
    Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, CP 02990, Mexico City, Mexico.
    Tan, Ai Lyn
    NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
    Nune, Arvind
    Southport and Ormskirk Hospital NHS Trust, Southport, PR8 6PN, UK.
    Cavagna, Lorenzo
    Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia, Pavia, Lombardy, Italy.
    Saavedra, Miguel A.
    Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico.
    Shinjo, Samuel Katsuyuki
    Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
    Ziade, Nelly
    Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
    Knitza, Johannes
    Medizinische Klinik 3-Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland.
    Distler, Oliver
    Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
    Wibowo, Suryo Anggoro Kusumo
    Rheumatology Division, Department of Internal Medicine, Fakultas Kedokteran Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
    Chinoy, Hector
    Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK; Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
    Aggarwal, Rohit
    Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
    Agarwal, Vikas
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
    Makol, Ashima
    Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
    Correlates of breakthrough COVID-19 in vaccinated patients with systemic sclerosis: survival analysis from a multicentre international patient-reported survey2024In: Rheumatology International, ISSN 0172-8172, E-ISSN 1437-160X, Vol. 44, no 1, p. 89-97Article in journal (Refereed)
    Abstract [en]

    This study aimed to assess the incidence, predictors, and outcomes of breakthrough infection (BI) following coronavirus disease (COVID-19) vaccination in patients with systemic sclerosis (SSc), a risk group associated with an immune-suppressed state and high cardiopulmonary disease burden. Cross-sectional data from fully vaccinated respondents with SSc, non-SSc autoimmune rheumatic diseases (AIRDs), and healthy controls (HCs) were extracted from the COVAD database, an international self-reported online survey. BI was defined according to the Centre for Disease Control definition. Infection-free survival was compared between the groups using Kaplan-Meier curves with log-rank tests. Cox proportional regression was used to assess the association between BI and age, sex, ethnicity, and immunosuppressive drugs at the time of vaccination. The severity of BI in terms of hospitalization and requirement for oxygen supplementation was compared between groups. Of 10,900 respondents, 6836 fulfilled the following inclusion criteria: 427 SSc, 2934 other AIRDs, and 3475 HCs. BI were reported in 6.3% of SSc, 6.9% of non-SSc AIRD, and 16.1% of HCs during a median follow-up of 100 (IQR: 60-137) days. SSc had a lower risk for BI than HC [hazard ratio (HR): 0.56 (95% CI 0.46-0.74)]. BIs were associated with age [HR: 0.98 (0.97-0.98)] but not ethnicity or immunosuppressive drugs at the time of vaccination. Patients with SSc were more likely to have asymptomatic COVID-19, but symptomatic patients reported more breathlessness. Hospitalization [SSc: 4 (14.8%), HCs: 37 (6.6%), non-SSc AIRDs: 32(15.8%)] and the need for oxygenation [SSc: 1 (25%); HC: 17 (45.9%); non-SSc AIRD: 13 (40.6%)] were similar between the groups. The incidence of BI in SSc was lower than that in HCs but comparable to that in non-SSc AIRDs. The severity of BI did not differ between the groups. Advancing age, but not ethnicity or immunosuppressive medication use, was associated with BIs.

  • 3.
    Ali, Sasha Saadia
    et al.
    Rheumatology Department, King's College Hospital, London, UK.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gupta, Latika
    Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
    Flares after COVID-19 infection in patients with idiopathic inflammatory myopathies: results from the COVAD study2023In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 62, no 9, p. e263-e268Article in journal (Refereed)
  • 4.
    Andersson, Siv Folkhammar
    et al.
    Unit of Rehabilitation, Kalmar County Council, Oskarshamn, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Henriksson, Elisabet Welin
    Divison of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Division of Nursing Science, Department of Medical and Health Science, Linköping University, Linköping, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden.
    Arthritis management in primary care: A study of physiotherapists' current practice, educational needs and adherence to national guidelines2017In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, no 4, p. 333-340Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis-related practice in physiotherapy and to study adherence to evidence-based care.

    METHODS: Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire.

    RESULTS: Sixty-four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA (p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA (p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA (p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment (p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA.

    CONCLUSIONS: PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care.

  • 5.
    Andreoli, L.
    et al.
    University of Brescia | ASST Spedali Civili, Dept Clinical and Experimental Sciences | Unit of Rheumatology and Clinical Immunology, Brescia, Italy.
    Lini, D.
    University of Brescia | ASST Spedali Civili, Dept Clinical and Experimental Sciences | Unit of Rheumatology and Clinical Immunology, Brescia, Italy.
    Schreiber, K.
    Danish Hospital for Rheumatic Diseases, Rheumatology, Sønderborg, Denmark; University of Southern Denmark, Department of Regional Health Research (IRS), Odense, Denmark; Guys and St Thomas’ NHS Foundation Trust, Thrombosis and Hemostasis, London, United Kingdom.
    Sen, P.
    Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, India.
    Ravichandran, N.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet and Karolinska University Hospital, Stockholm, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden; Faculty of Medicine and Health, Örebro University, Department of Rheumatology, Örebro, Sweden.
    Toro Gutierrez, C. E.
    Pontifica Universidad Javeriana, Reference Center for Osteoporosis, Rheumatology and Dermatology, Cali, Colombia.
    Katchamart, W.
    Mahidol University, Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
    Goo, P. A.
    Queen Savang Vadhana Memorial Hospital, Department of Medicine, Chonburi, Thailand.
    Shumnalieva, R.
    University Hospital “St. Ivan Rilski”, Department of Rheumatology, Sofia, Bulgaria.
    Chibuzo, O. C.
    University of Nigeria Teaching Hospital, Ituku-Ozalla/University of Nigeria, Enugu Campus, Department of Medicine, Enugu, Nigeria.
    Velikova, T.
    Sofia University St. Kliment Ohridski, Medical Faculty, Sofia, Bulgaria.
    Day, J.
    Institute of Medical Research, Walter and Eliza Hall, Parkville, Australia; University of Melbourne, Department of Medical Biology, Parkville, Australia; Royal Melbourne Hospital, Department of Rheumatology, Parkville, Australia.
    Joshi, M.
    Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospitals, Pune, India.
    Katsuyuki Shinjo, S.
    Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Division of Rheumatology, São Paulo, Brazil.
    Gracia-Ramos, A. E.
    National Medical Center “La Raza”, Instituto Mexicano del Seguro Social, Department of Internal Medicine, General Hospital, Mexico City, Mexico.
    Cavagna, L.
    University of Pavia, Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Pavia, Italy.
    Kuwana, M.
    Nippon Medical School Graduate School of Medicine, Department of Allergy and Rheumatology, Tokyo, Japan.
    Knitza, J.
    Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Germany.
    Makol, A.
    Mayo Clinic, Division of Rheumatology, Rochester, United States of America.
    Chen, Y. M.
    Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology, Department of Medical Research, Taichung, Taiwan, Republic of China.
    Chinoy, H.
    School of Biological Sciences, The University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, Manchester, United Kingdom; Manchester University NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom; Manchester Academic Health Science Centre, Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
    Agarwal, V.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India.
    Aggarwal, R.
    University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, United States of America.
    Gupta, L.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India; New Cross Hospital, Royal Wolverhampton Trust, Department of Rheumatology, Wolverhampton, United Kingdom.
    COVID-19 VACCINE SAFETY DURING PREGNANCY AND BREASTFEEDING IN WOMEN WITH AUTOIMMUNE DISEASES: RESULTS FROM THE COVAD STUDY2023In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 82, no Suppl. 1, p. 56-57, article id OP0082Article in journal (Other academic)
    Abstract [en]

    Background: COVID-19 vaccine hesitancy among pregnant and breastfeeding women with autoimmune diseases (AID) is often attributed to the fear of adverse events (AE) and disease flares (DF). No data are available regarding COVID-19 vaccine safety in this population.

    Objectives: We aimed at describing delayed-onset (>7 days) vaccine-related AE (minor and major), DF, and related AID treatment modifications from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

    Methods: Among complete responses from 9201 participants as of June 21, 2022, 6787 (73.8%) were women. Six subgroups were identified upon diagnosis of AID vs healthy controls (HC) and their pregnancy/breastfeeding status at the time of any dose of vaccine (Figure 1).

    Results: Forty pregnant and 52 breastfeeding AID patients were identified and their vaccination rates (at least one dose) was 100% and 96.2%, respectively (Table 1). Overall AE, minor AE, and major AE were reported significantly more frequently by pregnant than non-pregnant patients (45% vs. 26%, p=0.01; 40% vs. 25.9%, p=0.03; 17.5% vs. 4.6%, p<0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC. Post-vaccination DF were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18% of age- and disease-matched control patients (n=2315). All DF in pregnant/breastfeeding patients were managed with glucocorticoids and a fifth of them required initiation or change in immunosuppressive treatment.

    Conclusion: This study provides the first insights into the safety of COVID-19 vaccination during the antenatal period in women with AID. While AEs were more commonly reported by pregnant patients with AID, these were no higher than among pregnant healthy controls without AID. These observations are reassuring, likely to strengthen physician-patient communication and overcome hesitancy as the benefits for the mother and fetus by passive immunization are likely to overweigh the potential risks of AE and DF.

    Reference: [1]Fazal ZZ, et al; COVAD Study Group. COVAD survey 2 long-term outcomes: unmet need and protocol. Rheumatol Int 2022; 42:2151-2158.

  • 6.
    Andreoli, Laura
    et al.
    Rheumatology and Clinical ImmunologUnit, ASST Spedali Civili Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, 25123, Italy.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gupta, Latika
    Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK; Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
    COVID-19 vaccine safety during pregnancy and breastfeeding in women with autoimmune diseases: results from the COVAD study2023In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, article id kead382Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We investigated COVID-19 vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

    METHODS: Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares (DF), and AID-related treatment modifications were analyzed upon diagnosis of AID versus healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine.

    RESULTS: Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, p= 0.01; minor AE 40% vs 25.9%, p= 0.03; major AE 17.5% vs 4.6%, p< 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination DF were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a DF were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively.

    CONCLUSION: This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and the fetus by passive immunization appear to outweigh potential risks.

  • 7.
    Aoude, M.
    et al.
    Saint Joseph University of Beirut, Rheumatology Department, Beirut, Lebanon.
    Gupta, L.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India; The Royal Wolverhampton NHS Trust, Dept. of Rheumatology, Wolverhampton, United Kingdom.
    Hmamouchi, I.
    Temara Hospital, Rheumatology Unit, Temara, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco.
    Grignaschi, S.
    Fondazione I.R.C.C.S. Policlinico San Matteo, Rheumatology, Pavia, Italy; The University of Pavia, Department of Internal Medicine and Medical Therapeutics, Pavia, Italy.
    Cavagna, L.
    Fondazione I.R.C.C.S. Policlinico San Matteo, Rheumatology, Pavia, Italy; The University of Pavia, Department of Internal Medicine and Medical Therapeutics, Pavia, Italy.
    Kim, M.
    University of Illinois College of Medicine at Peoria, Department of Internal Medicine, Peoria, United States of America.
    R, N.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India.
    Lilleker, J. B.
    School of Biological Sciences University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Rochester, United Kingdom; Manchester Centre for Clinical Neurosciences, Clinical Neurosciences, Salford, United Kingdom.
    Sen, P.
    Maulana Azad Medical College(MAMC), Rheumatology, New Delhi, India.
    Agarwal, V.
    Mahatma Gandhi Mission Medical College, Navi Mumbai, India.
    Kardes, S.
    Istanbul University Faculty of Medicine, Department of Medical Ecology and Hydroclimatology, Istanbul, Turkey.
    Day, J.
    Royal Melbourne Hospital Neuroscience Foundation, Department of Rheumatology, Parkville, Australia; WEHI - Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; University of Melbourne, Department of Medical Biology, Parkville, Australia.
    Makol, A.
    Mayo Clinic, Division of Rheumatology, Rochester, United States of America.
    Milchert, M.
    Pomeranian Medical University, Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Szczecin, Poland.
    Gheita, T. A.
    Faculty Of Medicine Kasr Al-Ainy Cairo University, Rheumatology Department, Cairo, Egypt.
    Salim, B.
    Fauji Foundation Hospital Road, Rheumatology Department, Rawalpindi, Pakistan.
    Velikova, T.
    Lozenetz University Hospital, Department of Clinical Immunology, Sofia, Bulgaria.
    Gracia-Ramos, A. E.
    MSS, Department of Internal Medicine, Ciudad de México, Mexico.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska University Hospital, Division of Rheumatology, Stockholm, Sweden; Örebro University, Department of Rheumatology, Örebro, Sweden.
    Selva-O'callaghan, A.
    La Vall d’Hebron, Systemic Autoimmune Diseases Unit, Internal Medicine Department, Barcelona, Spain.
    Nikiphorou, E.
    King’s College London, Centre for Rheumatic Diseases, London, United Kingdom; King’s College Hospital, Dept of Rheumatology, London, United Kingdom.
    Chatterjee, T.
    University of Illinois College of Medicine at Peoria, Department of Internal Medicine, Peoria, United States of America.
    Tan, A. L.
    Leeds General Infirmary, NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom; University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom.
    Saavedra, M. A.
    Centro Medico Nacional La Raza, Departamento de Reumatología, Ciudad de México, Mexico.
    Shinjo, S. Katsuyuki
    Centro Medico Nacional La Raza, Departamento de Reumatología, Ciudad de México, Mexico.
    Knitza, J.
    University of Erlangen-Nuremberg, Medizinische Klinik 3 - Rheumatologie und Immunologie, Erlangen, Germany.
    Kuwana, M.
    Nippon Medical School, Department of Allergy and Rheumatology, Bunkyo City, Japan.
    Nune, A.
    Southport & Ormskirk Hospital NHS Trust, Southport, United Kingdom.
    Distler, O.
    University Hospital of Zürich, Rheumatology, Zürich, Switzerland.
    Chinoy, H.
    School of Biological Sciences University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Manchester, United Kingdom; NIHR Manchester Biomedical Research Unit, Manchester, United Kingdom; Salford Royal NHS Foundation Trust, Rheumatology, Manchester, United Kingdom.
    Aggarwal, R.
    University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, United States of America.
    Ziade, N.
    Saint Joseph University of Beirut, Rheumatology Department, Beirut, Lebanon; Hôtel-Dieu de France, Rheumatology Department, Beirut, Lebanon.
    TREATMENT PATTERNS OF IDIOPATHIC INFLAMMATORY MYOPATHIES: RESULTS FROM AN INTERNATIONAL COHORT OF OVER 1,400 PATIENTS2022In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 81, no Suppl. 1, p. 105-106Article in journal (Other academic)
  • 8.
    Arkema, E. V.
    et al.
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Rossides, M.
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    von Euler, Mia
    Clinical Science and Education and Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Svenungsson, E.
    Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden.
    Sjöwall, C.
    Department of Clinical and Experimental Medicine, Rheumatology/Division of Neuro and Inflammation Sciences, Linköping University, Linköping, Sweden.
    Simard, J. F.
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Health Research and Policy, Division of Epidemiology, Stanford School of Medicine, Stanford, CA, United States; Department of Medicine, Division of Immunology and Rheumatology, Stanford School of Medicine, Stanford, CA, United States.
    Response to: 'Increased stroke incidence in systemic lupus erythematosus patients: Risk factors or disease itself?' by Bruzzese and Zullo2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no 10, article id e72Article in journal (Other academic)
  • 9.
    Arkema, Elizabeth V.
    et al.
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Solna, Sweden.
    Svenungsson, Elisabet
    Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden.
    von Euler, Mia
    Department of Clinical Science and Education, Karolinska Institutet, Solna, Sweden; Stroke Research Network at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Sjöwall, Christopher
    Clinical and Experimental Medicine, Rheumatology/Division of Neuro and Inflammation Sciences, Linköping University, Linköping, Sweden.
    Simard, Julia F.
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Solna, Sweden; Department of Health Research and Policy, Division of Epidemiology, Stanford School of Medicine, Stanford, California, USA; Department of Medicine, Division of Immunology and Rheumatology, Stanford School of Medicine, Stanford, California, USA.
    Stroke in systemic lupus erythematosus: a Swedish population-based cohort study2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no 9, p. 1544-1549Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the occurrence of ischaemic and haemorrhagic stroke in systemic lupus erythematosus (SLE) compared with the general population by age, sex and time since SLE diagnosis METHODS: Adults with incident SLE were identified from the Swedish National Patient Register (NPR, n=3390) and general population comparators from the Total Population Register were matched on age, sex and county (n=16730). Individuals were followed prospectively until first of death, December 2013, emigration or incident stroke (identified from the NPR, Cause of Death Register and the Stroke Register). Incidence rates, rate differences and HR were estimated comparing SLE with non-SLE. Estimates were stratified by sex, age and time since diagnosis.

    RESULTS: We observed 126 strokes in SLE and 304 in the general population. Individuals with SLE had a twofold increased rate of ischaemic stroke compared with the general population (HR 2.2; 95% CI 1.7 to 2.8). The HR for intracerebral haemorrhage was 1.4 (95% CI 0.7 to 2.8). There was effect modification by sex and age, with the highest HRs for females and individuals <50 years old. The HR for ischaemic stroke was highest in the first year of follow-up (3.7; 95% CI 2.1 to 6.5).

    CONCLUSIONS: The relative risk of ischaemic stroke in SLE was more than doubled compared with the general population, and importantly, the highest relative risks were observed within the first year after SLE diagnosis. Thus, the first encounter with patients presents an opportunity for rheumatologists to screen for risk factors and intervene.

  • 10.
    Athlin, Simon
    et al.
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Spindler, Carl
    Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Hedlund, Jonas
    Strålin, Kristoffer
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
    Nauclér, Pontus
    Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Pneumococcal urinary antigen testing for antimicrobial guidance in community-acquired pneumonia: A register-based cohort study2022In: Journal of Infection, ISSN 0163-4453, E-ISSN 1532-2742, Vol. 85, no 2, p. 167-173Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the effect of pneumococcal urinary antigen test (UAT) usage on broad-spectrum antibiotic treatment in community-acquired pneumonia (CAP).

    METHODS: Patients admitted to 32 Swedish hospitals between 2011 and 2014 were retrospectively included from the Swedish National Quality Register of CAP. Using propensity score matched data, stratified by CRB-65 score, we studied the effect of performing UAT and of positive test results on treatment with broad-spectrum β-lactam monotherapy (BSBM) and antibiotics with coverage for atypical bacteria compared to narrow-spectrum β-lactam monotherapy (NSBM).

    RESULTS: UAT was performed for 4,995/14,590 (34.2%) patients, 603/4,995 (12.1%) of whom had positive test results. At day three, performing UAT was not associated with decreased use of BSBM (OR 1.07, 95% CI 0.94-1.23) but was associated with increased atypical coverage among patients with CRB-65 score 2 (OR 1.47, 95% CI 1.06-2.02). A positive UAT was associated with decreased BSBM use (OR 0.39, 95% CI 0.25-0.60) and decreased atypical coverage (OR 0.25, 95% CI 0.16-0.37), predominantly in non-severe CAP. At day one, performing UAT was associated with atypical coverage among patients with CRB-65 scores 2 (OR 2.60, 95% CI 1.69-3.98) and 3-4 (OR 3.69, 95% CI 1.55-8.79), and a positive test reduced the odds of BSBM treatment among CRB-65 score 3-4 patients (OR 3.49, 95% CI 1.02-12.0).

    CONCLUSIONS: Performing UAT had no overall effect on decreasing the use of BSBM treatment by day three of hospitalization, yet non-severely ill patients with positive UAT results were less likely to be treated with BSBM and antibiotics with atypical coverage.

  • 11.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Halasz, Laszlo
    Private practise, Lund, Sweden.
    Lange, Fredrik
    Private practise, Stockholm, Sweden.
    Lövgren, Peter W.
    Private practise, Stockholm, Sweden.
    Rosenbaum, Annika
    Private practise, Linköping, Sweden.
    Leboeuf-Yde, Charlotte
    Institute of Regional Health Research, Spine Centre of Southern Denmark, Hospital Lillebælt, University of Southern Denmark, Kolding, Denmark.
    Jensen, Irene
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Clustering patients on the basis of their individual course of low back pain over a six month period2011In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 12, article id 99Article in journal (Refereed)
    Abstract [en]

    Background: Several researchers have searched for subgroups in the heterogeneous population of patients with non-specific low back pain (LBP). To date, subgroups have been identified based on psychological profiles and the variation of pain.

    Methods: This multicentre prospective observational study explored the 6- month clinical course with measurements of bothersomeness that were collected from weekly text messages that were sent by 176 patients with LBP. A hierarchical cluster analysis, Ward's method, was used to cluster patients according to the development of their pain.

    Results: Four clusters with distinctly different clinical courses were described and further validated against clinical baseline variables and outcomes. Cluster 1, a "stable" cluster, where the course was relatively unchanged over time, contained young patients with good self- rated health. Cluster 2, a group of "fast improvers" who were very bothered initially but rapidly improved, consisted of patients who rated their health as relatively poor but experienced the fewest number of days with bothersome pain of all the clusters. Cluster 3 was the "typical patient" group, with medium bothersomeness at baseline and an average improvement over the first 4-5 weeks. Finally, cluster 4 contained the "slow improvers", a group of patients who improved over 12 weeks. This group contained older individuals who had more LBP the previous year and who also experienced most days with bothersome pain of all the clusters.

    Conclusions: It is possible to define clinically meaningful clusters of patients based on their individual course of LBP over time. Future research should aim to reproduce these clusters in different populations, add further clinical variables to distinguish the clusters and test different treatment strategies for them.

  • 12.
    Baumbach, L.
    et al.
    Res. Unit for Musculoskeletal Function and Physiotherapy, Dept. of Sports Sci. and Clinical Biomechanics, Univ. of Southern Denmark, Odense, Denmark.
    Ankerst, D.
    Dept. of Mathematics and Sch.of Life Sci. Technical Univ. of Munich, Munich, Germany.
    Nyberg, Lillemor A.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Cottrell, E.
    Primary Care Ctr. Versus Arthritis, Keele Univ., Keele, United Kingdom.
    Roos, E. M.
    Res. Unit for Musculoskeletal Function and Physiotherapy, Dept. of Sports Sci. and Clinical Biomechanics, Univ. of Southern Denmark, Odense, Denmark.
    Lykkegaard, J.
    Dept. of Publ. Hlth., Res. Unit for Gen. Practice, Univ. of Southern Denmark, Odense, Denmark.
    ASSOCIATION BETWEEN RECEIVING DIFFERENT ELEMENTS OF CARE AND SATISFACTION WITH CARE IN PATIENTS WITH KNEE OSTEOARTHRITIS TREATED BY THEIR GENERAL PRACTITIONER2020In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 28, p. S450-S450, article id 670Article in journal (Refereed)
  • 13.
    Bejerot, Susanne
    et al.
    Örebro University, School of Medical Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden.
    Hesselmark, Eva
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Mobarrez, Fariborz
    Unit of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden.
    Wallén, Håkan
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden.
    Hietala, Max Albert
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nybom, Rolf
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Wetterberg, Lennart
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report2019In: Journal of Medical Case Reports, E-ISSN 1752-1947, Vol. 13, no 1, article id 27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Neuromyelitis optica spectrum disorders are severe autoimmune inflammatory diseases of the central nervous system associated with the presence of immunoglobulin G antibodies against the water channel protein aquaporin-4. During exacerbation, specific aquaporin-4 immunoglobulin G may be produced intrathecally. We measured extracellular aquaporin-4 microparticles in the cerebrospinal fluid of a patient who later developed the typical symptoms and signs of a neuromyelitis optica spectrum disorder.

    CASE PRESENTATION: A 17-year-old South American girl developed acute severe motor and vocal tics and difficulties in walking, peripheral numbness, muscle pain, and bilateral headache. At age 22, she had a multitude of motor and psychiatric symptoms. Over the years, she fulfilled the diagnostic criteria for anorexia nervosa, depression, sleep disorder, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, development coordination disorder, attention-deficit/hyperactivity disorder, hypomania, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, conversion disorder, psychosis, and schizotypal personality syndrome. At age 24, she was found to have elevated titers of aquaporin-4 antibodies in serum, suggestive of probable neuromyelitis optica. She subsequently developed visual impairment, and swollen optic nerves were verified by magnetic resonance imaging. She was thus treated with a chimeric monoclonal antibody targeted against the pan-B-cell marker CD20 (rituximab), and almost all symptoms, including the psychiatric symptoms, rapidly decreased. We found a significant increase of extracellular microparticles of aquaporin-4 in cerebrospinal fluid sampled from our patient when she was 22 years old, 2 years before the full clinical development of neuromyelitis optica.

    CONCLUSIONS: Microparticles of aquaporin-4 represent subcellular arrangements that may influence the pathogenesis of neuromyelitis optica spectrum disorders and may serve as biomarkers for the underlying cellular disturbances. The increase of aquaporin-4 microparticles in cerebrospinal fluid may be used for early diagnostic purposes; for prevention; and for evaluation of effective treatment, long-term follow-up studies, and elucidating the pathophysiology in neuromyelitis optica spectrum disorders. Further studies of aquaporin-4 microparticles in cerebrospinal fluid of patients with neuromyelitis optica and similar neuropsychiatric disorders are thus called for.

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    Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report
  • 14.
    Bergens, Oscar
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Andreas
    Örebro University, School of Health Sciences.
    Kadi, Fawzi
    Örebro University, School of Health Sciences.
    Associations between Circulating Inflammatory Biomarkers and Indicators of Muscle Health in Older Men and Women2021In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 22, article id 5316Article in journal (Refereed)
    Abstract [en]

    Systemic inflammation is believed to contribute to declining muscle health during aging. The present study aims to examine associations between indicators of muscle health and pro- and anti-inflammatory biomarkers in older men and women, while also considering the impacts of physical activity and protein intake. An assessment of skeletal muscle index (SMI) by bioelectrical impedance analysis, handgrip strength, and 5-sit-to-stand time, using standardized procedures, was conducted in a population of older men (n = 90) and women (n = 148) aged 65-70 years. The inflammatory biomarkers C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, IL-10, IL-18, tumor necrosis factor (TNF)-α, monocyte chemoattractant protein-1, and macrophage inflammatory protein-1α were assessed in blood samples. Data were analyzed and stratified according to biological sex using multiple linear regression models. In older women, SMI was inversely associated with the pro-inflammatory markers CRP (β = -0.372; p < 0.05), fibrinogen (β = -0.376; p < 0.05), and IL-6 (β = -0.369; p < 0.05). Importantly, these associations were independent of abdominal adiposity (waist circumference), protein intake, physical activity level, as well as any adherence to muscle strengthening guidelines (≥2 sessions/week). In contrast, no corresponding associations were observed in men. In conclusion, our findings indicate the detrimental influence of a pro-inflammatory environment on muscle health regardless of important lifestyle-related factors in older women. However, the lack of such associations in older men highlights the importance of considering biological sex when examining the complex interaction between the systemic inflammatory environment and muscle health.

  • 15.
    Bergström, Cecilia
    et al.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Hagberg, Jan
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain2011In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 12, article id 81Article in journal (Refereed)
    Abstract [en]

    Background: The overall objective was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the MPI, the MPI-S, among gainfully employed workers with neck pain (NP) and/or low back pain (LBP) during a follow-up period of 18 and 36 months.

    Methods: This is a prospective cohort study that is part of a larger longitudinal multi-centre study entitled Work and Health in the Process and Engineering Industries (AHA). The attempt was to classify individuals at risk for developing chronic disabling NP and LBP. This is the first study using the MPI-questionnaire in a working population with NP and LBP.

    Results: Dysfunctional individuals (DYS) demonstrated more statistically significant sickness absence compared to adaptive copers (AC) after 36 months. DYS also had a threefold increase in the risk ratio of long-term sickness absence at 18 months. Interpersonally distressed (ID) subgroup showed overall more sickness absence compared to the AC subgroup at the 36-month follow-up and had a twofold increase in the risk ratio of long-term sickness absence at 18 months. There was a significant difference in bodily pain, mental and physical health for ID and DYS subgroups compared to the AC group at both follow-ups.

    Conclusions: The present study shows that this multidimensional approach to the classification of individuals based on psychological and psychosocial characteristics can distinguish different groups in gainfully employed working population with NP/LBP. The results in this study confirm the predictive validity of the MPI-S subgroup classification system.

  • 16.
    Björk, Mathilda
    et al.
    Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Unit of Occupational Therapy, Linköping University, Norrköping, Sweden.
    Dragioti, Elena
    Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Alexandersson, Helene
    Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm; Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Esbensen, Bente Appel
    Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Boström, Carina
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Friden, Cecilia
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden.
    Hjalmarsson, Sara
    Swedish Rheumatism Association, Stockholm, Sweden.
    Hörnberg, Kristina
    Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.
    Kjeken, Ingvild
    National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Vinderen, Oslo, Norway.
    Regardt, Malin
    Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm Sweden; Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet Stockholm, Sweden.
    Sundelin, Gunnevi
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Sverker, Annette
    Department of Activity and Health and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Welin, Elisabet
    Örebro University, School of Health Sciences.
    Brodin, Nina
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden; Danderyd Hospital Corp., Department of Orthopaedics, Division of Physiotherapy, Stockholm, Sweden.
    Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-reported Function: A Systematic Review and Meta-analysis2022In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 74, no 1, p. 31-43Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: Although physical activity (PA) is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), PA's effect on self-reported function and Quality of Life (QoL) has not been analyzed. This study synthesizes the evidence for the effectiveness of PA on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA).

    METHODS: The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using RoB 2.0 tool), and data extraction were independently performed by two or more of the authors. The meta-analyses were conducted with a random-effects model.

    RESULTS: The systematic review included 55 RCTs and the meta-analysis included 37 RCTs. In 55 studies included, 76% investigated RA, 20% investigated SpA, and 4% investigated PsA. In RA effects were found on QoL and function compared to inactive controls, effects not sustained in comparison to active controls. In SpA the effects of PA on QoL were in favor of the control group. Effects on function were found compared to inactive controls and sustained in fatigue and pain when compared to active controls. In PsA no effects on QoL were found but on function compared to inactive controls. The effect size was below 0.30 in the majority of the comparisons.

    CONCLUSION: PA may improve QoL and self-reported function in RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.

  • 17.
    Blomgran, Robert
    et al.
    Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden .
    Patcha Brodin, Veronika
    Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden .
    Verma, Deepti
    Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden .
    Bergström, Ida
    Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden .
    Söderkvist, Peter
    Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden .
    Sjöwall, Christopher
    Division of Rheumatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Eriksson, Per
    Division of Rheumatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Lerm, Maria
    Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Center for Infectious Medicine, Karolinska Institute Huddinge, Stockholm, Sweden .
    Stendahl, Olle
    Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden .
    Särndahl, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Common genetic variations in the NALP3 inflammasome are associated with delayed apoptosis of human neutrophils2012In: PLOS ONE, E-ISSN 1932-6203, Vol. 7, no 3, article id e31326Article in journal (Refereed)
    Abstract [en]

    Background: Neutrophils are key-players in the innate host defense and their programmed cell death and removal are essential for efficient resolution of inflammation. These cells recognize a variety of pathogens, and the NOD-like receptors (NLRs) have been suggested as intracellular sensors of microbial components and cell injury/stress. Some NLR will upon activation form multi-protein complexes termed inflammasomes that result in IL-1 beta production. NLR mutations are associated with auto-inflammatory syndromes, and our previous data propose NLRP3 (Q705K)/CARD-8 (C10X) polymorphisms to contribute to increased risk and severity of inflammatory disease by acting as genetic susceptibility factors. These gene products are components of the NALP3 inflammasome, and approximately 6.5% of the Swedish population are heterozygote carriers of these combined gene variants. Since patients carrying the Q705K/C10X polymorphisms display leukocytosis, the aim of the present study was to find out whether the inflammatory phenotype was related to dysfunctional apoptosis and impaired clearance of neutrophils by macrophages.

    Methods and Findings: Patients carrying the Q705K/C10X polymorphisms displayed significantly delayed spontaneous as well as microbe-induced apoptosis compared to matched controls. Western blotting revealed increased levels and phosphorylation of Akt and Mcl-1 in the patients' neutrophils. In contrast to macrophages from healthy controls, macrophages from the patients produced lower amounts of TNF; suggesting impaired macrophage clearance response.

    Conclusions: The Q705K/C10X polymorphisms are associated with delayed apoptosis of neutrophils. These findings are explained by altered involvement of different regulators of apoptosis, resulting in an anti-apoptotic profile. Moreover, the macrophage response to ingestion of microbe-induced apoptotic neutrophils is altered in the patients. Taken together, the patients display impaired turnover and clearance of apoptotic neutrophils, pointing towards a dysregulated innate immune response that influences the resolution of inflammation. The future challenge is to understand how microbes affect the activation of inflammasomes, and why this interaction will develop into severe inflammatory disease in certain individuals.

  • 18.
    Borg, Alexander
    et al.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Lindblom, Julius
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Gomez, Alvaro
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Soltani, Ameneh
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Enman, Yvonne
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Heintz, Emelie
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
    Regardt, Malin
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Grannas, David
    Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Emamikia, Sharzad
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Obesity is associated with pain and impaired mobility despite therapy in systemic lupus erythematosus2023In: Frontiers in Medicine, E-ISSN 2296-858X, Vol. 10, article id 1247354Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate whether abnormal BMI is associated with health-related quality of life (HRQoL) impairments, defined as patient-reported problems within the different dimensions of the three-level EQ-5D (EQ-5D-3L), before and after treatment for active systemic lupus erythematosus (SLE).

    PATIENTS AND METHODS: We conducted a post-hoc analysis of data from two phase III clinical trials of belimumab in SLE, i.e., BLISS-52 (n = 865) and BLISS-76 (n = 819). Underweight was defined as BMI <18.5 kg/m2, normal weight as BMI ≥18.5 but <25 kg/m2, pre-obesity as BMI ≥25 but <30 kg/m2, and obesity as BMI ≥30 kg/m2. We investigated associations between BMI groups and problems (level 2 or 3) within each one of the five EQ-5D dimensions before treatment initiation and at week 52, using logistic regression analysis adjusting for age, ethnicity, disease activity, and glucocorticoid dose, and for the post-treatment analysis also for belimumab treatment and baseline EQ-5D-3L responses.

    RESULTS: Of 1,684 patients included, 73 (4%) were classified as underweight, 850 (50%) as normal weight, 438 (26%) as pre-obese, and 323 (19%) as obese. At baseline, obesity was associated with mild to severe problems in all EQ-5D dimensions (p < 0.05 for all), yielding the strongest association with problems in mobility (adjusted odds ratio, aOR: 2.1; 95% confidence interval, CI: 1.6-2.8; p < 0.001). Pre-obesity was also associated with problems in mobility (aOR: 1.4; 95% CI: 1.1-1.8; p = 0.005). Post-intervention, obesity was associated with problems in mobility and pain/discomfort, and pre-obesity with problems in mobility and self-care (p < 0.05 for all).

    CONCLUSION: Our study adds to the evidence that high BMI negatively affects SLE patients' HRQoL, with obesity being associated with pain and impaired mobility despite therapy.

  • 19.
    Brolin, S.
    et al.
    Karolinska University Hospital, Department of Gastroenterology, Dermatology and Rheumatology, Stockholm, Sweden.
    Lövström, B.
    Karolinska University Hospital, Department of Gastroenterology, Dermatology and Rheumatology, Stockholm, Sweden.
    Welin, Elisabet
    Örebro University, School of Health Sciences.
    Gunnarsson, I.
    Karolinska University Hospital, Department of Gastroenterology, Dermatology and Rheumatology, Stockholm, Sweden; Karolinska Institutet, Rheumatology, Stockholm, Sweden.
    Pettersson, S.
    Karolinska University Hospital, Department of Gastroenterology, Dermatology and Rheumatology, Stockholm, Sweden.
    THE NEED FOR INFORMATION AMONG PATIENTS WITH ANCA ASSOCIATED VASCULITIS DIFFERS BETWEEN GROUPS2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, no Suppl. 1, p. 1023-1023, article id POS1476-HPArticle in journal (Other academic)
  • 20.
    Broström, E W
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Esbjörnsson, A-C
    Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    von Heideken, J
    Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Larsson, P
    Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Wretenberg, Per
    Örebro University Hospital. Department of Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Iversen, M
    Department of Physical Therapy, Brigham and Women's Hospital, Northeastern University, Boston MA, United States.
    Change in Gait Deviation Index after anti-tumour necrosis factor-α treatment in individuals with rheumatoid arthritis: a pilot study2013In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 42, no 5, p. 356-361Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Anti-tumour necrosis factor-alpha (TNF-α) inhibitors provide fast, effective resolution of rheumatoid arthritis (RA) inflammation. In this study we aimed to quantify the impact of TNF-α treatment on gait dynamics.

    METHOD: The sample comprised 16 subjects [11 female, median age 56 (range 48-66) years, median disease duration 9.5 (range 4.6-20.6) years] with RA who met the American College of Rheumatology (ACR) criteria, had lower extremity involvement, did not use walking aids, and had started TNF-α treatment within 1 week of baseline gait analysis. Gait analysis focused on three-dimensional (3D) lower extremity joint kinematics, kinetics, time and distance parameters. The Gait Deviation Index (GDI) and GDI-Kinetic were calculated. Data on gait, disease activity, and physical disability were collected at baseline and at 3.5 months.

    RESULTS: Following treatment with TNF-α, statistically significant improvements were found in disease activity [using the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP); median difference (m(d)) = 2.3, p < 0.01], physical disability [Health Assessment Questionnaire (HAQ) m(d) = 0.4, p < 0.01], and pain during walking [visual analogue scale (VAS) m(d) = 11.0, p < 0.05]. Reductions in gait deviations were noted (GDI m(d) = 3.7, p = 0.04; GDI-Kinetic m(d) = 4.1, p = 0.05) along with reductions in dimensionless time and distance parameters. A moderate to good negative correlation existed between baseline GDI and GDI change scores (r(s) = -0.7, p < 0.01).

    CONCLUSIONS: Treatment with TNF-α improved gait dynamics in adults with RA. Significant gait deviations were, however, still present after treatment. In this study, GDI and GDI-Kinetic scores appeared to be useful outcome measures to quantify changes in gait deviations after this intervention.

  • 21.
    Brotto, Davide
    et al.
    Department of Neurosciences, University of Padova, Padova, Italy.
    Manara, Renzo
    Neuroradiology, Sezione di Neuroscienze, University of Salerno, Salerno, Italy.
    Vio, Stefania
    Radiology Unit, Azienda Ospedaliera di Padova, Padova, Italy.
    Ghiselli, Sara
    Department of Neurosciences, University of Padova, Padova, Italy.
    Cantone, Elena
    ENT section, Neurosciences Department, Federico II, Naples, Italy.
    Mardari, Rodica
    Neuroradiology, University Hospital of Padova, Padova, Italy.
    Toldo, Irene
    Pediatric Neurology Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy.
    Stritoni, Valentina
    TIPED, Department of Pediatrics, University of Padova, Padova, Italy.
    Castiglione, Alessandro
    Department of Neurosciences, University of Padova, Padova, Italy.
    Lovo, Elisa
    Department of Neurosciences, University of Padova, Padova, Italy.
    Trevisi, Patrizia
    Department of Neurosciences, University of Padova, Padova, Italy.
    Bovo, Roberto
    Department of Neurosciences, University of Padova, Padova, Italy.
    Martini, Alessandro
    Department of Neurosciences, University of Padova, Padova, Italy.
    Salivary glands abnormalities in oculo-auriculo-vertebral spectrum2018In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 22, no 1, p. 395-400Article in journal (Refereed)
    Abstract [en]

    Background: Feeding and swallowing impairment are present in up to 80% of oculo-auriculo-vertebral spectrum (OAVS) patients. Salivary gland abnormalities have been reported in OAVS patients but their rate, features, and relationship with phenotype severity have yet to be defined.

    Material and methods: Parotid and submandibular salivary gland hypo/aplasia was evaluated on head MRI of 25 OAVS patients (16 with severe phenotype, Goldenhar syndrome) and 11 controls.

    Results: All controls disclosed normal salivary glands. Abnormal parotid glands were found exclusively ipsilateral to facial microsomia in 21/25 OAVS patients (84%, aplasia in six patients) and showed no association with phenotype severity (14/16 patients with Goldenhar phenotype vs 7/9 patients with milder phenotype, p = 0.6). Submandibular salivary gland hypoplasia was detected in six OAVS patients, all with concomitant ipsilateral severe involvement of the parotid gland (p < 0.001). Submandibular salivary gland hypoplasia was associated to Goldenhar phenotype (p < 0.05). Parotid gland abnormalities were associated with ipsilateral fifth (p < 0.001) and seventh cranial nerve (p = 0.001) abnormalities. No association was found between parotid gland anomaly and ipsilateral internal carotid artery, inner ear, brain, eye, or spine abnormalities (p > 0.6).

    Conclusions: Salivary gland abnormalities are strikingly common in OAVS. Their detection might help the management of OAVS-associated swallowing and feeding impairment.

  • 22.
    Burkill, Sarah
    et al.
    Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Sweden; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Sweden; Department of Epidemiology and Public Health, University College London, UK.
    Kockum, Ingrid
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Sweden.
    Piehl, Fredrik
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Sweden.
    Strid, Pernilla
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Sweden.
    Hillert, Jan
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Olsson, Tomas
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Sweden.
    Bahmanyar, Shahram
    Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Sweden; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Sweden.
    The association between multiple sclerosis and pain medications2019In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 2, p. 424-432Article in journal (Refereed)
    Abstract [en]

    Patients with multiple sclerosis (MS) are at greater risk of pain than people without the disease; however, the occurrence and characteristics of pain among these patients are incompletely described. We aimed to assess characteristics of pain amongst MS patients using MS patients who were recruited to participate in 3 studies in Sweden (n = 3877) and were matched with individuals without MS (n = 4548) by sex, year of birth, and region of residence. The Prescribed Drugs Register identified prescribed pain medication, overall and restricted to those given 4 or more prescriptions in 1 year to assess chronic pain. Anatomical therapeutic chemical codes classified whether pain was neuropathic, musculoskeletal, or migraine. Cox-proportional hazard models were used to estimate associations. Our findings showed patients with MS were at increased risk of pain treatment, with a hazard ratio (HR) of 2.52 (95% confidence interval 2.38-2.66). The largest magnitude HR was for neuropathic pain (5.73, 5.07-6.47) for which 34.2% (n = 1326) of the MS and 7.15% (n = 325) of the non-MS cohort were prescribed a treatment. The HR for chronic pain treatment was 3.55 (3.27-3.84), indicating an increased effect size relative to any pain treatment. Chronic neuropathic pain showed the largest HR at 7.43 (6.21-8.89). Neuropathic pain was shown to be the primary mechanism leading to increased risk of pain in patients with MS.

  • 23.
    Burkill, Sarah
    et al.
    Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
    Smith, Kelsi A.
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.
    Stridh, Pernilla
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden.
    Kockum, Ingrid
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden.
    Hillert, Jan
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
    Lindahl, Hannes
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Olsson, Tomas
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden.
    Piehl, Fredrik
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Bahmanyar, Shahram
    Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.
    The DQB1* 03:02 Genotype and Treatment for Pain in People With and Without Multiple Sclerosis2020In: Frontiers in Neurology, E-ISSN 1664-2295, Vol. 11, article id 993Article in journal (Refereed)
    Abstract [en]

    Murine models have demonstrated that the major histocompatibility complex (MHC) is associated with pain-like behavior in peripheral nerve injury, however, the same association has not been shown when considering injury to the central nervous system (CNS), which more closely mimics the damage to the CNS experienced by MS patients. Previous research has indicated the DQB1*03:02 allele of the class II HLA genes as being associated with development of neuropathic pain in persons undergoing inguinal hernia surgery or with lumbar spinal disk herniation. Whether this HLA allele plays a part in susceptibility to pain, has not, as far as we are aware, been previously investigated. This study utilizes information on DQB1*03:02 alleles as part of the EIMS, GEMS, and IMSE studies in Sweden. It also uses register data for 3,877 MS patients, and 4,548 matched comparators without MS, to assess whether the DQB1*03:02 allele is associated with prescribed pain medication use, and whether associations with this genotype differ depending on MS status. Our results showed no association between the DQB1*03:02 genotype and pain medication in MS patients, with an adjusted odds ratio (OR) of 1.02 (95% CI 0.85-1.24). In contrast, there was a statistically significant association of low magnitude in individuals without MS [adjusted OR 1.18 (95% CI 1.03-1.35)], which provides support for HLA influence on susceptibility to pain in the general population. Additionally, the effect of zygosity was evident for the non-MS cohort, but not among MS patients, suggesting the DQB1*03:02 allele effect is modified by the presence of MS.

  • 24. Carli, C.
    et al.
    Ehlin, A. G. C.
    Klareskog, L.
    Lindblad, S.
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Trends in disease modifying antirheumatic drug prescription in early rheumatoid arthritis are influenced more by hospital setting than patient or disease characteristics2006In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 65, no 8, p. 1102-1105Article in journal (Refereed)
    Abstract [en]

    Objective: To characterise temporal trends and factors associated with the prescription of disease modifying antirheumatic drugs (DMARDs) at the initial consultation in early rheumatoid arthritis (RA).

    Methods: Data from 2584 patients with early RA at 19 hospitals were extracted from the Swedish Rheumatoid Arthritis Register for the period 1997–2001. Disease characteristics and DMARD prescription at first consultation with the rheumatologist were investigated using cross tabulation and logistic regression.

    Results: DMARD prescriptions, particularly for methotrexate, increased from 1997 to 2001 independently of patient characteristics. Stratification by hospital type showed that patients in district hospitals were less likely to be prescribed DMARDs than those in university hospitals (adjusted odds ratio (OR) = 0.53 (95% confidence interval (CI) 0.40 to 0.69), p<0.001), independently of confounding factors. Association of the DAS28 with the likelihood of DMARD prescription was greater among patients attending district hospitals (OR = 1.65 (1.34 to 2.02), p<0.001) than those at university hospitals (OR = 1.23 (1.07 to 1.41), p = 0.003) and county hospitals (OR = 1.34 (1.01 to 1.63), p = 0.003). Interaction testing indicated that the difference was significant (p = 0.007).

    Conclusions: Temporal trends in DMARD prescription indicate an increasingly aggressive approach to disease management among Swedish rheumatologists. However, the association of hospital type with DMARD prescription suggests that the adoption of research findings in clinical care varies considerably.

  • 25.
    Da Mutten, Raffaele
    et al.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden.
    Borg, Alexander
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, 17176 Stockholm, Sweden.
    Chatzidionysiou, Katerina
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, 17176 Stockholm, Sweden.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden.
    Intracardiac Thrombi in Morbus Adamantiades-Behçet in Two Swedish Patients2023In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 16, article id 5377Article in journal (Refereed)
    Abstract [en]

    Morbus Adamantiades-Behçet (MAB) is an inflammatory disease typically manifesting with oral and genital aphthosis, erythema nodosum, and vasculopathy, and in only around 2%, cardiac involvement. Its prevalence is usually higher along the historic Silk Road, but rarer in Scandinavia where 0.64-4.9 in 100,000 people are affected. We herein present two Swedish patients with cardiac manifestations of Morbus Adamantiades-Behçet. Along with the intracardial thrombi, which both patients presented with, one patient also had cerebrovascular insults leading to visual field deficits as well as involvement of peripheral nerves. Being of Scandinavian origin and showing uncommon symptoms as their initial manifestations of MAB, the 62- and 35-year-old patients presenting herein constitute rare cases.

  • 26.
    Danielsson, Olof
    et al.
    Dept Clin & Expt Med, Div Neurol, Fac Hlth Sci, Linköping University, Linköping, Sweden; Div Clin Immunol, Fac Hlth Sci, Linköping University, Linköping, Sweden; Dept Neurol, Cty Council Östergötland, Linköping, Sweden; Dept Clin Immunol & Transfus Med, Cty Council Östergötland, Linköping, Sweden.
    Lindvall, Björn
    Dept Neurol, Örebro University Hospital, Örebro, Sweden.
    Gati, Istvan
    Dept Clin & Expt Med, Div Neurol, Fac Hlth Sci, Linköping University, Linköping, Sweden; Div Clin Immunol, Fac Hlth Sci, Linköping University, Linköping, Sweden; Dept Neurol, Cty Council Östergötland, Linköping, Sweden; Dept Clin Immunol & Transfus Med, Cty Council Östergötland, Linköping, Sweden.
    Ernerudh, Jan
    Classification and Diagnostic Investigation in Inflammatory Myopathies: A Study of 99 Patients2013In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 40, no 7, p. 1173-1182Article in journal (Refereed)
    Abstract [en]

    Objective. Insights into the pathogenesis of inflammatory myopathies have led to new diagnostic methods. The aims of our study were (1) to evaluate the consequences of using the classification of Amato/European Neuromuscular Centre Workshop (ENMC), compared to that of Bohan and Peter; and (2) to evaluate any diagnostic benefit in using an extended pathological investigation. Methods. From a consecutive retrospective database, we evaluated 99 patients for classification. Patients with inclusion body myositis (IBM) were classified according to Griggs, et al. In addition to routine stainings and immunohistochemistry, a multilevel serial sectioning procedure was performed on paraffin-embedded material, to identify scarce pathological findings. Results. Classification according to Bohan and Peter could be performed for 83 of the 99 patients, whereas only 60 patients met the Amato/ENMC criteria, the latter resulting in the following diagnostic groups: IBM (n = 18), nonspecific myositis (n = 14), polymyositis (n = 12), dermatomyositis (n = 10), dermatomyositis sine dermatitis (n = 5), and immune-mediated necrotizing myopathy (n = 1). Most of the Amato/ENMC diagnostic groups harbored patients from several of the Bohan and Peter groups, which included a substantial group lacking proximal muscle weakness. The serial sectioning procedure was essential for classification of 9 patients (15%), and led to a more specific diagnosis for 13 patients (22%) according to Amato/ENMC. Conclusion. The classification of Amato/ENMC was more restrictive, forming groups based on clinical criteria and specified myopathological findings, which clearly differed from the groups of the Bohan and Peter classification. An extended pathological investigation increased the diagnostic yield of a muscle biopsy and highlights the quantity and specificity of certain pathological findings.

  • 27.
    Deminger, Anna
    et al.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Klingberg, Eva
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lorentzon, Mattias
    Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Geijer, Mats
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Radiology, Örebro University Hospital, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Göthlin, Jan
    Department of Radiology, Sahlgrenska University Hospital, Mölndal, Sweden.
    Hedberg, Martin
    Section of Rheumatology, Södra Älvsborg Hospital, Borås, Sweden.
    Rehnberg, Eva
    Section of Rheumatology, Alingsås Hospital, Alingsås, Sweden.
    Carlsten, Hans
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jacobsson, Lennart T.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Forsblad-d'Elia, Helena
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden.
    Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study2017In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 19, article id 273Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies have shown increased prevalence of osteoporosis and increased risk for vertebral fractures in patients with ankylosing spondylitis (AS). Measurements of bone mineral density (BMD) in the lumbar spine anterior-posterior (AP) projection may be difficult to interpret due to the ligamentous calcifications, and the lateral projection might be a better measuring site. Our objectives were to investigate BMD changes after 5 years at different measuring sites in patients with AS and to evaluate disease-related variables and medications as predictors for BMD changes.

    METHODS: In a longitudinal study, BMD in Swedish AS patients, 50 ± 13 years old, was measured with dual-energy x-ray absorptiometry (DXA) at the hip, the lumbar spine AP and lateral projections, and the total radius at baseline and after 5 years. Patients were assessed with questionnaires, blood samples, and spinal radiographs for grading of AS-related alterations in the spine with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and assessment of vertebral fractures by the Genant score. Multiple linear regression analyses were used to investigate predictors for BMD changes.

    RESULTS: Of 204 patients included at baseline, 168 (82%) were re-examined after 5 years (92 men and 76 women). BMD decreased significantly at the femoral neck and radius and increased significantly at the lumbar spine, both for AP and lateral projections. Mean C-reactive protein during follow-up predicted a decrease in the femoral neck BMD (change in %, β = -0.15, p = 0.046). Use of bisphosphonates predicted an increase in BMD at all measuring sites (p < 0.001 to 0.013), except for the total radius. Use of tumor necrosis factor inhibitors (TNFi) predicted an increase in AP spinal BMD (β = 3.15, p = 0.012).

    CONCLUSION: The current study (which has a long follow-up, many measuring sites, and is the first to longitudinally assess the lateral projection of the spine in AS patients) surprisingly showed that lateral projection spinal BMD increased. This study suggests that the best site to assess bone loss in AS patients is the femoral neck and that inflammation has an adverse effect, and the use of bisphosphonates and TNFi has a positive effect, on BMD in AS patients.

  • 28.
    Dey, Mrinalini
    et al.
    Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK.
    Doskaliuk, Bohdana
    Department of Pathophysiology, Ivano-Frankivsk National Medical University, 76018 Ivano-Frankivsk, Ukraine.
    Lindblom, Julius
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Nikiphorou, Elena
    Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK; Rheumatology Department, King's College Hospital, London, UK.
    Wincup, Chris
    Rheumatology Department, King's College Hospital, London, UK.
    Fathima, Madiha
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Saha, Sreoshy
    Mymensingh Medical College, Mymensingh, Bangladesh.
    Shaharir, Syahrul Sazliyana
    Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
    Katchamart, Wanruchada
    Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10100, Thailand.
    Goo, Phonpen Akarawatcharangura
    Department of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand.
    Traboco, Lisa
    Department of Medicine, Section of Rheumatology, St. Luke's Medical Center-Global City, Taguig, Philippines.
    Chen, Yi-Ming
    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
    Kadam, Esha
    Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, Maharashtra, India.
    Lilleker, James B.
    Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.
    Nune, Arvind
    Southport and Ormskirk Hospital NHS Trust, Southport, UK.
    Pauling, John D.
    Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, North Bristol NHS Trust, Bristol, UK.
    Agarwal, Vishwesh
    Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India.
    Dey, Dzifa
    Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Korle-Bu, Accra, Ghana.
    Toro Gutierrez, Carlos Enrique
    Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali, Cali 760046, Colombia.
    Caballero, Carlo Vinicio
    Department of Medicine, Hospital Universidad del Norte, Barranquilla, Colombia.
    Chinoy, Hector
    Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
    Aggarwal, Rohit
    Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, USA.
    Agarwal, Vikas
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
    Gupta, Latika
    Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    COVID-19 Vaccination-Related Delayed Adverse Events among Patients with Systemic Lupus Erythematosus2023In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 24, article id 7542Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The safety profile of COVID-19 vaccination is well documented, but hesitancy among people with immune-mediated inflammatory diseases, often immunocompromised, remains high, partially due to a scarcity of data on safety over a longer term. We herein aimed to assess delayed adverse events (DAEs) occurring >7 days after COVID-19 vaccination in systemic lupus erythematosus (SLE) versus other rheumatic autoimmune diseases (rAIDs), non-rheumatic AIDs (nrAIDs), and healthy controls (HCs).

    METHODS: Self-reported data were captured within the COVID-19 Vaccination in Autoimmune Diseases (COVAD)-2 online survey, which comprised >150 centres and responses from 106 countries, between February and June 2022. Logistic regression analysis adjusting for important confounders (age, sex, ethnicity) was used to compare groups.

    RESULTS: Of 7203 eligible individuals, 882 (12.2%) patients had SLE, 3161 (43.9%) patients had rAIDs, 426 (5.9%) patients had nrAIDs, and 2734 (38.0%) were HCs. SLE patients had a median age of 39 years (IQR: 31-50); 93.7% were women. SLE patients reported, more frequently, major DAEs (OR: 1.6; 95% CI: 1.2-2.0; p = 0.001) and hospitalisation (OR: 2.2; 95% CI: 1.4-3.4; p < 0.001) compared to HCs, severe rashes (OR: 2.4; 95% CI: 1.3-4.2; p = 0.004) compared to people with rAIDS, and hospitalisation (OR: 2.3; 95% CI: 1.1-4.9; p = 0.029) as well as several minor DAEs compared to people with nrAIDs. Differences were observed between vaccines in terms of frequency of major DAEs and hospitalisations, with the latter seen more frequently in patients receiving the Moderna vaccine. People with SLE with no autoimmune multimorbidity less frequently reported overall minor DAEs compared to SLE patients with comorbid nrAIDs (OR: 0.5; 95% CI: 0.3-1.0; p = 0.036).

    CONCLUSION: Hospitalisations post-vaccination were more frequent in SLE patients than in HCs. Monitoring of SLE patients following COVID-19 vaccination can help in identifying DAEs early, informing patients about expected DAEs, and supporting patients, especially those with autoimmune multimorbidity.

  • 29.
    Dey, Mrinalini
    et al.
    Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Rheumatology, Countess of Chester Hospital NHS Foundation Trust, Chester, UK.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gupta, Latika
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
    Higher risk of short term COVID-19 vaccine adverse events in myositis patients with autoimmune comorbidities: results from the COVAD study2023In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 62, no 5, p. e147-e152Article in journal (Refereed)
  • 30.
    Dey, Mrinalini
    et al.
    Institute of Life Course and Medical Sciences, University of Liverpool, Brownlow Hill, Liverpool, UK; Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nikiphorou, Elena
    Rheumatology Department, King's College Hospital, London, UK; Centre for Rheumatic Diseases, King's College London, London, UK.
    Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management2021In: Journal of clinical medicine, E-ISSN 2077-0383, Vol. 10, no 16, article id 3566Article, review/survey (Refereed)
    Abstract [en]

    Fatigue is a common constitutional feature of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). While the two diseases share a common mechanism of autoimmunity, they differ in their clinical manifestations and treatment. Fatigue is one of the most commonly reported symptoms in both groups, associated with pain, depression and anxiety, and affecting function, work and quality of life. Fatigue is not easy to assess or conceptualise. It can be linked to disease activity, although it is not always, and is challenging to treat. Several measures have been trialled in RA and SLE; however, none have been adopted into mainstream practice. Despite being a common symptom, fatigue remains poorly managed in both RA and SLE-more so in the latter, where there have been relatively fewer studies. Additionally, comorbidities contribute to fatigue, further complicating its management. Pain, depression and anxiety also need to be addressed, not as separate entities, but together with fatigue in a holistic manner. Here, we describe the similarities and differences between fatigue in patients with RA and SLE, discuss concepts and practices applicable to both conditions and identify areas for further research. Through this review, we aim to highlight the importance of the holistic management of fatigue in SLE.

  • 31.
    Doskaliuk, Bohdana
    et al.
    Department of Pathophysiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gupta, Latika
    Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
    Long-term safety of COVID vaccination in individuals with idiopathic inflammatory myopathies: results from the COVAD study2023In: Rheumatology International, ISSN 0172-8172, E-ISSN 1437-160X, Vol. 43, no 9, p. 1651-1664Article in journal (Refereed)
    Abstract [en]

    Limited evidence on long-term COVID-19 vaccine safety in patients with idiopathic inflammatory myopathies (IIMs) continues to contribute to vaccine hesitancy. We studied delayed-onset vaccine adverse events (AEs) in patients with IIMs, other systemic autoimmune and inflammatory disorders (SAIDs), and healthy controls (HCs), using data from the second COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. A validated self-reporting e-survey was circulated by the COVAD study group (157 collaborators, 106 countries) from Feb-June 2022. We collected data on demographics, comorbidities, IIM/SAID details, COVID-19 history, and vaccination details. Delayed-onset (> 7 day) AEs were analyzed using regression models. A total of 15165 respondents undertook the survey, of whom 8759 responses from vaccinated individuals [median age 46 (35-58) years, 74.4% females, 45.4% Caucasians] were analyzed. Of these, 1390 (15.9%) had IIMs, 50.6% other SAIDs, and 33.5% HCs. Among IIMs, 16.3% and 10.2% patients reported minor and major AEs, respectively, and 0.72% (n = 10) required hospitalization. Notably patients with IIMs experienced fewer minor AEs than other SAIDs, though rashes were expectedly more than HCs [OR 4.0; 95% CI 2.2-7.0, p < 0.001]. IIM patients with active disease, overlap myositis, autoimmune comorbidities, and ChadOx1 nCOV-19 (Oxford/AstraZeneca) recipients reported AEs more often, while those with inclusion body myositis, and BNT162b2 (Pfizer) recipients reported fewer AEs. Vaccination is reassuringly safe in individuals with IIMs, with AEs, hospitalizations comparable to SAIDs, and largely limited to those with autoimmune multimorbidity and active disease. These observations may inform guidelines to identify high-risk patients warranting close monitoring in the post-vaccination period.

  • 32.
    Edström, Måns
    et al.
    Clinical and Experimental Medicine, Faculty of Health Sciences, Division of Clinical Immunology, Unit of Autoimmunity and Immune Regulation, Linköping University, Sweden.
    Mellergård, J.
    Clinical and Experimental Medicine, Faculty of Health Sciences, Division of Neurology, Linköping University, Sweden.
    Mjösberg, J.
    Clinical and Experimental Medicine, Faculty of Health Sciences, Division of Clinical Immunology, Unit of Autoimmunity and Immune Regulation, Linköping University, Sweden.
    Jenmalm, M. C.
    Clinical and Experimental Medicine, Faculty of Health Sciences, Division of Clinical Immunology, Unit of Autoimmunity and Immune Regulation, Linköping University, Sweden; Clinical and Experimental Medicine, Faculty of Health Sciences, Division of Paediatrics, Unit of Autoimmunity and Immune Regulation Linköping University, Sweden.
    Vrethem, M.
    Clinical and Experimental Medicine, Faculty of Health Sciences, Division of Neurology, Linköping University, Sweden.
    Press, R.
    Department of Neurology, Huddinge University Hospital, Karolinska Institute, Huddinge, Sweden.
    Dahle, C.
    Clinical and Experimental Medicine, Faculty of Health Sciences, Division of Neurology, Linköping University, Sweden.
    Ernerudh, J.
    Clinical and Experimental Medicine, Faculty of Health Sciences, Division of Clinical Immunology, Unit of Autoimmunity and Immune Regulation, Linköping University, Sweden.
    Transcriptional characteristics of CD4+ T cells in multiple sclerosis: Relative lack of suppressive populations in blood2011In: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 17, no 1, p. 57-66Article in journal (Refereed)
    Abstract [en]

    Background: Multiple sclerosis (MS) is hypothetically caused by autoreactive Th1 and Th17 cells, whereas Th2 and regulatory T cells may confer protection. The development of Th subpopulations is dependant on the expression of lineage-specific transcription factors.

    Objective: The aim of this study was to assess the balance of CD4(+)T cell populations in relapsing-remitting MS.

    Methods: Blood mRNA expression of TBX21, GATA3, RORC, FOXP3 and EBI3 was assessed in 33 patients with relapsing-remitting MS and 20 healthy controls. In addition, flow cytometry was performed to assess T lymphocyte numbers.

    Results: In relapsing-remitting MS, diminished expression of FOXP3 (Treg) was found (p < 0.05), despite normal numbers of CD4(+)CD25(hi)Treg. Immunoregulatory EBI3 and Th2-associated GATA3 ([a-z]+) was also decreased in MS (p < 0.005 and p < 0.05, respectively). Expression of TBX21 (Th1) and RORC (Th17) did not differ between patients and controls. Similar changes were observed when analysing beta-interferon treated (n = 12) or untreated (n = 21) patients. Analysis of transcription factor ratios, comparing TBX21/GATA3 and RORC/FOXP3, revealed an increase in the RORC/FOXP3 ratio in patients with relapsing-remitting MS (p < 0.005).

    Conclusion: Our findings indicate systemic defects at the mRNA level, involving downregulation of beneficial CD4(+)phenotypes. This might play a role in disease development by permitting activation of harmful T cell populations.

  • 33.
    Edvinsson, Marie
    et al.
    Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden.
    Welvaart, Nicole
    Örebro University, School of Medical Sciences. Department of Orthopaedics.
    Ryttberg, Lars
    Department of Orthopaedics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Wretenberg, Per
    Örebro University, School of Medical Sciences. Department of Orthopaedics.
    Vikerfors, Tomas
    Department of Infectious Diseases, Örebro University, Örebro, Sweden; Västerås Central Hospital, Västerås, Sweden.
    Nyström-Rosander, Christina
    Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden.
    No evidence of Chlamydia pneumoniae in the synovia of patients with osteoarthritis2019In: Journal of international medical research, ISSN 0300-0605, E-ISSN 1473-2300, Vol. 47, no 2, p. 635-640Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Osteoarthritis (OA) is a common cause of disability affecting millions of people of all ages worldwide. The pathogenesis involves an inflammatory component, but the cause of the inflammation remains incompletely understood. The intracellular bacteria Chlamydia trachomatis and C. pneumoniae have been demonstrated in patients with reactive arthritis. Both of these microorganisms can cause chronic and persistent infections, with C. trachomatis being the most common cause of reactive arthritis. This study was performed to investigate the presence of C. pneumoniae in a large number of patients with primary OA.

    METHODS: The study included 75 patients who underwent total knee arthroplasty. During surgery, a synovial biopsy was performed and synovial fluid drawn. Real-time polymerase chain reaction (PCR) of C. pneumoniae was run on all patients, and real-time PCR of bacterial 16S rDNA was conducted on 30 of the 75 patients to screen for the presence of other bacteria.

    RESULTS: Real-time PCR showed no evidence of the presence of C. pneumoniae in the patients' specimens, nor were other bacteria detected.

    CONCLUSIONS: Although an inflammatory component is part of the pathogenesis of OA, we found no evidence indicating that C. pneumoniae is a stimulator of that inflammation.

  • 34.
    Eklund, Andreas
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Axén, Iben
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Research Department, Spine Center of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, Middelfart, Denmark.
    Do psychological and behavioral factors classified by the West Haven-Yale Multidimensional Pain Inventory (Swedish version) predict the early clinical course of low back pain in patients receiving chiropractic care?2016In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 17, no 1, article id 75Article in journal (Refereed)
    Abstract [en]

    Background: To investigate if psychological and behavioral factors (as determined by the Swedish version of the West Haven-Yale Multidimensional Pain Inventory, MPI-S) can predict the early clinical course of Low Back Pain (LBP).

    Methods: MPI-S data from patients (18–65 years of age) seeking chiropractic care for recurrent and persistent LBP were collected at the 1st visit. A follow-up questionnaire was administered at the 4th visit. The predictive value of the MPI-S subgroups Adaptive Copers (AC), Interpersonally Distressed (ID) and Dysfunctional (DYS) was calculated against the subjective improvement at the 4th visit and clinically relevant difference in pain intensity between the 1st and 4th visit.

    Results: Of the 666 subjects who were included at the 1st visit, 329 completed the questionnaire at the 4th visit. A total of 64.7 % (AC), 68.0 % (ID) and 71.3 % (DYS) reported a definite improvement. The chance of “definite improvement”, expressed as relative risk (95 % CI) with the AC group as reference, was 1.05 (.87–1.27) for the ID and 1.10 (.93–1.31) for the DYS groups, respectively. The DYS and ID groups reported higher values in pain intensity both at the 1st and the 4th visit. The proportion of subjects who reported an improvement in pain intensity of 30 % or more (clinically relevant) were 63.5 % AC, 72.0 % ID and 63.2 % DYS. Expressed as relative risk (95 % CI) with the AC group as reference, this corresponded to 1.26 (.91–1.76) for the ID and 1.09 (.78–1.51) for the DYS groups, respectively.

    Conclusions: The MPI-S instrument could not predict the early clinical course of recurrent and persistent LBP in this sample of chiropractic patients.

  • 35.
    Eklund, Andreas
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Axén, Iben
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden; Research Department, Spine Center of Southern Denmark, Institute of Regional Health Research, Hospital Lillebælt, Middelfart, Denmark.
    Psychological and behavioral differences between low back pain populations: a comparative analysis of chiropractic, primary and secondary care patients2015In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 16, article id 306Article in journal (Refereed)
    Abstract [en]

    Background: Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics.

    Methods: In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared. A: Four hundred eighty subjects from chiropractic primary care clinics. B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity). C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic. D: Two hundred thirty-five subjects from secondary care clinics. The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed).

    Results: The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D.

    Conclusions: The chiropractic primary care sample was more affected by pain and worse off with regards to psychological and behavioral characteristics compared to the other primary care sample. Based on our findings from the MPI-S instrument the 4 samples may be considered statistically and clinically different.

  • 36. Elefteria, Dhima
    et al.
    Ejdervik Lindblad, Birgitta
    Örebro University, School of Medical Sciences.
    Central serous chorioretinopathy as a first sign of severe undiagnosed SLE in a pregnant woman2017Conference paper (Refereed)
  • 37.
    Emamikia, S.
    et al.
    Karolinska Institutet and Karolinska University Hospital, Division of Rheumatology, Department of Medicine, Solna, Sweden.
    Gentline, C.
    Karolinska Institutet and Karolinska University Hospital, Division of Rheumatology, Department of Medicine, Solna, Sweden.
    Enman, Y.
    Karolinska Institutet and Karolinska University Hospital, Division of Rheumatology, Department of Medicine, Solna, Sweden.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet and Karolinska University Hospital, Division of Rheumatology, Department of Medicine, Solna, Sweden; Örebro University, Department of Rheumatology, Faculty of Medicine and Health, Örebro, Sweden.
    CAN WE ENHANCE ADHERENCE TO MEDICATIONS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS? RESULTS FROM A QUALITATIVE STUDY2022In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 81, no Suppl. 1, p. 439-439, article id POS0371Article in journal (Other academic)
  • 38.
    Emamikia, Sharzad
    et al.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Gentline, Cidem
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Enman, Yvonne
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    How Can We Enhance Adherence to Medications in Patients with Systemic Lupus Erythematosus? Results from a Qualitative Study2022In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 11, no 7, article id 1857Article in journal (Refereed)
    Abstract [en]

    Medication non-adherence is common among patients with systemic lupus erythematosus (SLE) and may lead to poor clinical outcomes. Our aim was to identify influenceable contributors to medication non-adherence and suggest interventions that could increase adherence. Patients with SLE from two Swedish tertiary referral centres (n = 205) participated in a survey assessing self-reported adherence to medications. Responses were used to select patients for qualitative interviews (n = 15). Verbatim interview transcripts were analysed by two researchers using content analysis methodology. The median age of the interviewees was 32 years, 87% were women, and their median SLE duration was nine years. Reasons for non-adherence were complex and multifaceted; we categorised them thematically into (i) patient-related (e.g., unintentional non-adherence due to forgetfulness or intentional non-adherence due to disbelief in medications); (ii) healthcare-related (e.g., untrustworthy relationship with the treating physician, authority fear, and poor information about the prescribed medications or the disease); (iii) medication-related (e.g., fear of side-effects); and (iv) disease-related reasons (e.g., lacking acceptance of a chronic illness or perceived disease quiescence). Interventions identified that healthcare could implement to improve patient adherence to medications included (i) increased communication between healthcare professionals and patients; (ii) patient education; (iii) accessible healthcare, preferably with the same personnel; (iv) well-coordinated transition from paediatric to adult care; (v) regularity in addressing adherence to medications; (vi) psychological support; and (vii) involvement of family members or people who are close to the patient.

  • 39.
    Emamikia, Sharzad
    et al.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Oon, Shereen
    Departments of Medicine and Rheumatology, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia.
    Gomez, Alvaro
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Lindblom, Julius
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Borg, Alexander
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Enman, Yvonne
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Morand, Eric
    School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre Clayton, Clayton, Victoria, Australia.
    Grannas, David
    Divison of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    van Vollenhoven, Ronald F.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
    Nikpour, Mandana
    Departments of Medicine and Rheumatology, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Impact of remission and low disease activity on health-related quality of life in patients with systemic lupus erythematosus2022In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 61, no 12, p. 4752-4762Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the impact of remission and lupus low disease activity state (LLDAS) on health-related quality of life (HRQoL) in systemic lupus erythematosus.

    METHODS: SF-36, EQ-5D-3L and FACIT-Fatigue data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials were used. Duration in remission/LLDAS required to reach a HRQoL benefit ≥ minimal clinically important differences (MCIDs) during and post-treatment was determined using quantile regression and generalised estimating equations.

    RESULTS: Patients (N = 1684) were assessed every 4th week (15 visits). Four cumulative (β = 0.60) or four consecutive (β = 0.66) visits in remission were required to achieve a benefit ≥MCID in SF-36 physical component summary (PCS) scores, and six cumulative (β = 0.44) or five consecutive (β = 0.49) for a benefit ≥MCID in mental component summary (MCS) scores. Eight cumulative (β = 0.30 for both) or eight consecutive (β = 0.32 for both) visits in LLDAS were required for a benefit in PCS/MCS ≥MCID, respectively.For EQ-5D-3L index scores ≥MCID, six cumulative (β = 0.007) or five consecutive (β = 0.008) visits in remission were required, and eight cumulative (β = 0.005) or six consecutive (β = 0.006) visits in LLDAS. For FACIT-Fatigue scores ≥MCID, 12 cumulative (β = 0.34) or 10 consecutive (β = 0.39) visits in remission were required, and 17 cumulative (β = 0.24) or 16 consecutive (β = 0.25) visits in LLDAS.

    CONCLUSION: Remission and LLDAS contribute to a HRQoL benefit in a time-dependent manner. Shorter time in remission than in LLDAS was required for a clinically important benefit in HRQoL, and longer time in remission for a benefit in mental compared with physical HRQoL aspects. When remission/LLDAS was sustained, the same benefit was achieved in a shorter time.

  • 40.
    Emamikia, Sharzad
    et al.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Oon, Shereen
    Department of Rheumatology, St Vincent’s Hospital, Fitzroy, Australia.
    Gomez, Alvaro
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Lindblom, Julius
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Borg, Alexander
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Enman, Yvonne
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Morand, Eric
    School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre Clayton, Melbourne, Australia.
    Grannas, David
    Divison of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, Stockholm, Sweden.
    van Vollenhoven, Ronald
    Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam Rheumatology Center, Amsterdam, Netherlands.
    Nikpour, Mandana
    University of Melbourne at St Vincent’s Hospital, Melbourne, Australia.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    The Impact of Remission and Low Disease Activity Attainment on Health-related Quality of Life in Two Phase III Clinical Trials of Belimumab in Systemic Lupus Erythematosus2021In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 73, no Suppl. 9, p. 2604-2606, article id 1261Article in journal (Other academic)
    Abstract [en]

    Background/Purpose: Health- related quality of life (HRQoL) is considered one of the most important outcomes in clinical trials of systemic lupus erythematosus (SLE), along with reduction in disease activity and safety. We studied the duration and consecutiveness of remission or low disease activity throughout a 52- week long period on standard therapy plus belimumab or placebo in relation to HRQoL outcome.

    Methods: We analysed pooled 52- week data from the BLISS- 52 (N=865) and BLISS- 76 (N=819) phase III trials. We determined remission using the prevailing Definitions of Remission in SLE (DORIS) definition (1) and low disease activity using the Lupus Low Disease Activity State (LLDAS) (2). Remission required clinical (c)SLEDAI- 2K=0, PhGA (0– 3) <0.5, and prednisone ≤5 mg/day. LLDAS required SLEDAI- 2K ≤4, PhGA (0– 3) ≤1, and prednisone ≤7.5 mg/day. HRQoL was measured with the SF- 36 physical and mental component summary (PCS and MCS), and EQ- 5D- 3L. Minimal clinically important difference (MCID) at week 52 for PCS and MCS was set to 2.5, and for EQ- 5D- 3L utility index to 0.040. Associations were assessed using quantile regression analysis. Adjustments for demographics, disease duration, organ damage and baseline status were incorporated.

    Results: The minimum cumulative attainment of remission to achieve a benefit in PCS ≥MCID at week 52 was four visits (corresponding to 16 weeks) (β=0.63), while 7 visits (28 weeks) were required for MCS differences ≥MCID (β=0.37). Correspondingly, 9 visits in LLDAS (36 weeks) were required for achieving differences ≥MCID in both PCS (b=0.28) and MCS (β=0.29). Table 1 shows 95% confidence intervals and p values. When analysing the impact of sustained remission and LLDAS, four consecutive visits in remission (16 weeks) were required for PCS ≥MCID (b=0.70), whereas six visits (24 weeks) were required for MCS ≥MCID (b=0.46). Sustained LLDAS for nine consecutive visits (36 weeks) was needed for PCS and MCS ≥MCID (b=0.31 and 0.31, respectively). For EQ- 5D ≥MCID to be reached, a cumulative total of seven visits (28 weeks) in remission (b=0.006), or eight visits (32 weeks) in LLDAS (b=0.005) was required, whereas if sustained, remission for six visits (24 weeks; b=0.008) or LLDAS for seven visits (28 weeks; b=0.006) were sufficient.

    Conclusion: Attainment of remission or LLDAS in the BLISS- 52 and BLISS- 76 trials of belimumab was associated with improved HRQoL. Less time was required in remission than in LLDAS to achieve clinically important differences in multiple HRQoL aspects. Clinically important differences in HRQoL required shorter total time if the remission or LLDAS was sustained. Clinically important differences in mental aspects of HRQoL required longer time in remission than physical aspects. The impact of cumulative and sustained remission or LLDAS on HRQoL adds evidence on the clinical importance of these treat- to- target endpoints.

    References:1) van Vollenhoven R. et al. Ann Rheum Dis. 20172) Franklyn K. et al. Ann Rheum Dis. 2016

  • 41.
    Esbjörnsson, A-C
    et al.
    Department of Women's and Children's Health, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden.
    Rozumalski, A
    Gillette Children's Specialty Healthcare, St Paul MN, United States; Department of Biomedical Engineering, University of Minnesota, Minneapolis MN, United States.
    Iversen, M D
    Department of Physical Therapy, Bouve College of Health Sciences, Northeastern University, Boston MA, United States; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston MA, United States.
    Schwartz, M H
    Gillette Children's Specialty Healthcare, St Paul MN, United States; Department of Biomedical Engineering, University of Minnesota, Minneapolis MN, United States; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis MN, United States.
    Wretenberg, Per
    Örebro University Hospital. Department of Molecular Medicine, Section of Orthopaedics, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Broström, E W
    Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Quantifying gait deviations in individuals with rheumatoid arthritis using the Gait Deviation Index2014In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 43, no 2, p. 124-131Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: In this study we evaluated the usability of the Gait Deviation Index (GDI), an index that summarizes the amount of deviation in movement from a standard norm, in adults with rheumatoid arthritis (RA). The aims of the study were to evaluate the ability of the GDI to identify gait deviations, assess inter-trial repeatability, and examine the relationship between the GDI and walking speed, physical disability, and pain.

    METHOD: Sixty-three adults with RA and 59 adults with typical gait patterns were included in this retrospective case-control study. Following a three-dimensional gait analysis (3DGA), representative gait cycles were selected and GDI scores calculated. To evaluate the effect of walking speed, GDI scores were calculated using both a free-speed and a speed-matched reference set. Physical disability was assessed using the Health Assessment Questionnaire (HAQ) and subjects rated their pain during walking.

    RESULTS: Adults with RA had significantly increased gait deviations compared to healthy individuals, as shown by lower GDI scores [87.9 (SD = 8.7) vs. 99.4 (SD = 8.3), p < 0.001]. This difference was also seen when adjusting for walking speed [91.7 (SD = 9.0) vs. 99.9 (SD = 8.6), p < 0.001]. It was estimated that a change of ≥ 5 GDI units was required to account for natural variation in gait. There was no evident relationship between GDI and low/high RA-related physical disability and pain.

    CONCLUSIONS: The GDI seems to useful for identifying and summarizing gait deviations in individuals with RA. Thus, we consider that the GDI provides an overall measure of gait deviation that may reflect lower extremity pathology and may help clinicians to understand the impact of RA on gait dynamics.

  • 42.
    Fanouriakis, Antonis
    et al.
    Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
    Kostopoulou, Myrto
    Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
    Andersen, Jeanette
    Lupus Europe, Copenhagen, Denmark.
    Aringer, Martin
    Division of Rheumatology, Department of Medicine III, University Medical Center & Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany.
    Arnaud, Laurent
    Department of Rheumatology, Hôpitaux Universitaires de Strasbourg, INSERM UMR-S 1109, Centre National de Référence des Maladies Auto-immunes Systémiques Rares (RESO), Strasbourg, France.
    Bae, Sang-Cheol
    Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research and Hanyang Institute of Bioscience and Biotechnology, Seoul, South Korea.
    Boletis, John
    Department of Nephrology and Renal Transplantation Unit, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
    Bruce, Ian N.
    Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK; National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
    Cervera, Ricard
    Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.
    Doria, Andrea
    Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
    Dörner, Thomas
    Department of Rheumatology and Clinical Immunology, Charite Universitätsmedizin Berlin; Deutsches Rheumaforschungszentrum, Berlin, Germany.
    Furie, Richard A.
    Division of Rheumatology, Northwell Health, Great Neck, New York City, New York, USA.
    Gladman, Dafna D.
    Lupus Program, Centre for Prognosis Studies in the Rheumatic Disease, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
    Houssiau, Frederic A.
    Service de Rhumatologie, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
    Inês, Luís Sousa
    Department of Rheumatology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal; School of Health Sciences, Universidade da Beira Interior, Covilha, Portugal.
    Jayne, David
    Department of Medicine, University of Cambridge, Cambridge, UK.
    Kouloumas, Marios
    Cyprus League Against Rheumatism, Aglantzia, Cyprus.
    Kovács, László
    Department of Rheumatology and Immunology, Faculty of Medicine, University of Szeged, Hungary.
    Mok, Chi Chiu
    Department of Medicine, Tuen Mun Hospital, Hong Kong, China.
    Morand, Eric F.
    Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
    Moroni, Gabriella
    Department of Biomedical Sciences Humanitas University, Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Milan, Italy.
    Mosca, Marta
    Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
    Mucke, Johanna
    Department of Rheumatology & Hiller Research Unit Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany.
    Mukhtyar, Chetan B.
    Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
    Nagy, György
    Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary; Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
    Navarra, Sandra
    Section of Rheumatology, Department of Medicine, University of Santo Tomas, Manila, Philippines.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pego-Reigosa, José M.
    Rheumatology Department, Complejo Hospitalario Universitario de Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) - VIGO Group, Galicia Sur Health Research Institute, Vigo, Spain.
    Petri, Michelle
    Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
    Pons-Estel, Bernardo A.
    Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
    Schneider, Matthias
    Department of Rheumatology & Hiller Research Unit Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany.
    Smolen, Josef S.
    Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
    Svenungsson, Elisabet
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Tanaka, Yoshiya
    First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
    Tektonidou, Maria G.
    Rheumatology Unit, First Department of Propaedeutic Internal Medicine, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Joint Academic Rheumatology Program, Athens, Greece.
    Teng, Yk Onno
    Centre of Expertise for Lupus-, Vasculitis- and Complement-mediated Systemic autoimmune diseases, Department of Internal Medicine - section Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
    Tincani, Angela
    Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy.
    Vital, Edward M.
    Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
    van Vollenhoven, Ronald F.
    Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
    Wincup, Chris
    Department of Rheumatology, King's College Hospital, London, UK.
    Bertsias, George
    Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece, University Hospital of Heraklion, Heraklion, Greece.
    Boumpas, Dimitrios T.
    Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece; Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece, Medical School, University of Cyprus, Nicosia, Cyprus.
    EULAR recommendations for the management of systemic lupus erythematosus: 2023 update2024In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 83, no 1, p. 15-29Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To update the EULAR recommendations for the management of systemic lupus erythematosus (SLE) based on emerging new evidence.

    METHODS: An international Task Force formed the questions for the systematic literature reviews (January 2018-December 2022), followed by formulation and finalisation of the statements after a series of meetings. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned, and participants finally provided their level of agreement with each item.

    RESULTS: The Task Force agreed on 5 overarching principles and 13 recommendations, concerning the use of hydroxychloroquine (HCQ), glucocorticoids (GC), immunosuppressive drugs (ISDs) (including methotrexate, mycophenolate, azathioprine, cyclophosphamide (CYC)), calcineurin inhibitors (CNIs, cyclosporine, tacrolimus, voclosporin) and biologics (belimumab, anifrolumab, rituximab). Advice is also provided on treatment strategies and targets of therapy, assessment of response, combination and sequential therapies, and tapering of therapy. HCQ is recommended for all patients with lupus at a target dose 5 mg/kg real body weight/day, considering the individual's risk for flares and retinal toxicity. GC are used as 'bridging therapy' during periods of disease activity; for maintenance treatment, they should be minimised to equal or less than 5 mg/day (prednisone equivalent) and, when possible, withdrawn. Prompt initiation of ISDs (methotrexate, azathioprine, mycophenolate) and/or biological agents (anifrolumab, belimumab) should be considered to control the disease and facilitate GC tapering/discontinuation. CYC and rituximab should be considered in organ-threatening and refractory disease, respectively. For active lupus nephritis, GC, mycophenolate or low-dose intravenous CYC are recommended as anchor drugs, and add-on therapy with belimumab or CNIs (voclosporin or tacrolimus) should be considered. Updated specific recommendations are also provided for cutaneous, neuropsychiatric and haematological disease, SLE-associated antiphospholipid syndrome, kidney protection, as well as preventative measures for infections, osteoporosis, cardiovascular disease.

    CONCLUSION: The updated recommendations provide consensus guidance on the management of SLE, combining evidence and expert opinion.

  • 43.
    Fornaro, M.
    et al.
    Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, Bari, Italy.
    Venerito, V.
    Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, Bari, Italy.
    Iannone, F.
    Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, Bari, Italy.
    Ravichandran, N.
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
    Nikiphorou, E.
    Centre for Rheumatic Diseases, King’s College London, London, United Kingdom; Rheumatology Department, King’s College Hospital, London, United Kingdom.
    Joshi, M.
    Byramjee Jeejeebhoy Government Medical College and Sassoon, General Hospitals, Pune, India.
    Tan, A. L.
    NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Saha, S.
    Mymensingh Medical College, Mymensingh, Bangladesh, Bangladesh.
    Shinjo, S. Katsuyuki
    Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
    Agarwal, V.
    Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India.
    Ziade, N.
    Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India.
    Velikova, T.
    Department of Clinical Immunology, Medical Faculty, University Hospital “Lozenetz”, Sofia University St. Kliment Ohridski, Sofia, Bulgaria.
    Jagtap, K.
    Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, Maharashtra, India.
    Milchert, M.
    Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Omeranian Medical University in Szczecin, Szczecin, Poland.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gracia-Ramos, A. E.
    Department of Internal Medicine, General Hospital, National Medical Center “La Raza”, Instituto Mexicano del Seguro Social, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, Mexico City, Mexico.
    Cavagna, L.
    Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia, Pavia, Italy.
    Kuwana, M.
    Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
    Knitza, J.
    Medizinische Klinik 3 – Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
    Makol, A.
    Division of Rheumatology, Mayo Clinic, Rochester Minnesota, United States of America.
    Dzifa, D.
    Department of Medicine and Therapeutics, University of Ghana School of Medicine and Dentistry, College of Health Sciences, Korle-Bu, Accra, Ghana.
    Toro Gutierrez, C. E.
    Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana, Cali, Colombia.
    Vinicio Caballero, C.
    Department of Medicine, Hospital Universidad del Norte, Barranquilla, Atlantico, Colombia.
    Distler, O.
    Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
    Day, J.
    Department of Rheumatology, Royal Melbourne Hospital, Parkville VIC, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville VIC, Australia; Department of Medical Biology, University of Melbourne, Parkville VIC, Australia.
    Chinoy, H.
    Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom; Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom.
    Aggarwal, R.
    Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh Pennsylvania, United States of America.
    Gupta, L.
    Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
    MULTIMORBIDITY AND PROMIS HEALTH OUTCOMES IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES: DATA FROM A LARGE, GLOBAL E-SURVEY (COVAD STUDY)2023In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 82, no Suppl. 1, p. 942-943, article id POS1216Article in journal (Other academic)
    Abstract [en]

    Background: Prevalence of comorbidities and their impact on health outcomes in Idiopathic inflammatory myopathies (IIMs) is limited.

    Objectives: This study aimed to explore the prevalence of multimorbidity in patients with IIMs, other autoimmune rheumatic diseases (AIRDs) and Healthy controls (HCs). We further explore the impact of comorbidities on patients’ physical, mental, and social health assessed by the Patient-Reported Outcome Measurement Information System (PROMIS instruments).

    Methods: Data for this study were acquired from the COVAD 2 e-survey hosted by a study group consisting of 167 collaborators in 110 countries. Basic multimorbidity (BM) was defined as the co-occurrence of two or more comorbidities in an individual, while complex multimorbidity (CM) signified the co-occurrence of 3 or more chronic conditions affecting 3 or more different organ systems. PROMIS global physical health (PGP), mental health (PGM), fatigue 4a (F4a) and physical function short form (SF10) were analysed using descriptive statistics and linear regression models. Hierarchical Clustering on Principal Components was performed to outline the grouping.

    Results: Of 10740 complete respondents, 1558 IIMs, 4591 AIRDs and 3652 HCs were analysed. Individuals with IIMs exhibited high burden of any comorbidity (OR: 1.62 vs AIRDs and 2.95 vs HCs,p<0.01), BM (OR 1.66 vs AIRDs and 3.52 vs HCs,p<0.01), CM (OR: 1.69 vs AIRDs and 6.23 vs HCs,p<0.01), and mental health disorders (MHDs) (OR 1.33 vs AIRDs and 2.63 vs HCs,p<0.01).

    IIM patients with comorbidities (and MHDs) had worse physical function (low PGP, PGM, SF10 and higher F4a scores, all p<0.001). Worse physical function (PGP) was predicted by age (0.35; 0.030), active disease (-1.51; <0.001), BM (-1.11; <0.001), and MHDs (-1.47; <0.001). PGM was impacted by age (0.51; 0.004), active disease (-1.34, <0.001), BM (-0.75; 0.001) and MHDs (-2.22; <0.001). Determinants of SF10a were age (-3.86; <0.001), active disease (-7.03, <0.001), female (2.85, <0.001), BM (-2.95; <0.001) and MHDs (-2.37; <0.001). Fatigue (F4a) was impacted by age (-0.96, <0.001), active disease (1.45, <0.001), country human development index (0.95; 0.036), BM (1.11; <0.001); and MHDs (2.17; <0.001).

    Four distinct clusters (Figure 1A, Table 1) were identified i.e., cluster 0: lower burden of comorbidities and good health status; cluster 1: older patients, whit higher burden of comorbidities and poor health status, cluster 2: patients with higher prevalence of MHDs, lower PGP and PGM; and higher F4a scores; and lastly Cluster 3 that comprised older patients with an average burden of comorbidities and overall good health status according to PROMIS scores.

    Dermatomyositis, anti-synthetase syndrome, necrotizing autoimmune myopathy were similarly represented in all clusters, whilst inclusion body myositis and polymyositis were more predominant in clusters 1 (40.6% and 17.2%) and 3 (32 % and 17.5%), while overlap myositis was more represented in cluster 2 (25.6%) and 0 (32.7%) (Figure 1B).

    Conclusion: Patients with IIMs have a higher burden of comorbidities that adversely impact physical and mental health, calling for optimized approaches for holistic patient management.

  • 44.
    Giannopoulou, N.
    et al.
    University of Nicosia, General Hospital of Paphos, Nicosia, Cyprus.
    Gupta, L.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India; Royal Wolverhampton Hospitals NHS Trust, Department of Rheumatology, Wolverhampton, United Kingdom; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Department of Rheumatology, Birmingham, United Kingdom; The University of Manchester, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, United Kingdom.
    Andreoli, L.
    Azienda Socio-Sanitaria Territoriale Spedali Civili, Rheumatology and Clinical Immunology Unit, Brescia, Italy; University of Brescia, Department of Clinical and Experimental Sciences, Brescia, Italy.
    Lini, D.
    Azienda Socio-Sanitaria Territoriale Spedali Civili, Rheumatology and Clinical Immunology Unit, Brescia, Italy; University of Brescia, Department of Clinical and Experimental Sciences, Brescia, Italy.
    Nikiphorou, E.
    King’s College London, Centre for Rheumatic Diseases, London, United Kingdom; King’s College Hospital, Rheumatology Department, London, United Kingdom.
    Aggarwal, R.
    University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Department of Medicine, Pittsburgh, United States of America.
    Agarwal, V.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet and Karolinska University Hospital, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden; Örebro University, Department of Rheumatology, Faculty of Medicine and Health, Örebro, Sweden.
    COVID-19 VACCINE SAFETY DURING PREGNANCY IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS2023In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 82, no Suppl. 1, p. 1495-1496, article id AB0591Article in journal (Other academic)
    Abstract [en]

    Background: Vaccinations comprise a part of the antenatal care of pregnant women, including patients with systemic lupus erythematosus (SLE) who are at increased risk of adverse pregnancy outcomes (APOs). While COVID-19 vaccination has been shown to be safe in patients with SLE, data on vaccine-associated adverse events (AEs) during the antenatal and lactation period are scarce or lacking.

    Objectives: To investigate the association between COVID-19 vaccination and AEs in pregnant SLE patients.

    Methods: A total of 9201 complete responses were extracted on June 21st, 2022 from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) 2 database, a global e-survey involving 157 collaborators from 106 countries. Among respondents, 6787 (73.8%) were women. We identified 70 (1.1%) women who were exposed to at least one COVID-19 vaccine dose during pregnancy, among those 11 with SLE. Delayed onset (>7 days) vaccine-related AEs were extracted and triangulated with disease activity, treatment changes due to flare after vaccination, and COVID-19 infections in vaccinated pregnant women with SLE. Additionally, information on health-related quality of life and physical function was recorded using PROMIS at the time of survey completion.

    Results: The age of patients ranged from 28 to 39 years; 5/11 women were of Asian origin. None of these patients reported major vaccine AEs, including four patients with self-reported active SLE prior to the vaccination. None of them reported any change in the status of their autoimmune disease, and no hospitalisation or special treatment was recorded. Six women experienced minor vaccine AEs; two of them had active disease prior to vaccination. Four patients reported COVID-19 infection; two of them while they were pregnant and post-vaccination and two prior to pregnancy and vaccination. All four patients experienced symptoms of their disease, but no overt SLE flare was reported. At the time of survey completion, all patients reported their general health as being good to excellent in all aspects evaluated. Importantly, no APOs were reported.

    None of the patients reported thrombotic events post-vaccination, which provides some reassurance regarding COVID-19 vaccination in a patient population with a high risk for cardiovascular comorbidity and thrombosis, especially in the presence of antiphospholipid antibodies or in patients diagnosed with the antiphospholipid syndrome, a considerable portion within SLE populations. Moreover, it was reassuring to note an absence of association between experienced vaccine AEs and active disease prior to vaccination. Although minor AEs were common, they did not impair daily functioning, and the symptoms resolved in all patients after a median of 3 (IQR: 2.5–5.0) days.

    Conclusion: Our report adds relevant evidence concerning the sensitive issue of COVID-19 vaccine AEs and flares in SLE patients during the antenatal and lactation period. Despite the small sample size, the findings provide some reassurance and can contribute to informed decisions regarding vaccination in patients with SLE and high-risk pregnancies due to their background autoimmune disease. Based on the present data, the risk/benefit ration of COVID-19 vaccination appears favourable, with vaccines both providing passive immunisation to the fetus and active immunisation to the mother with no signals of exacerbation of the mother’s autoimmune disease.

  • 45.
    Giannopoulou, Nefeli
    et al.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, sweden; Karolinska University Hospital, Stockholm, Sweden; General Hospital of Paphos, University of Nicosia, Nicosia, Cyprus.
    Gupta, Latika
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
    Andreoli, Laura
    Rheumatology and Clinical Immunology Unit, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
    Lini, Daniele
    Rheumatology and Clinical Immunology Unit, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
    Nikiphorou, Elena
    Centre for Rheumatic Diseases, King's College London, London, UK; Rheumatology Department, King's College Hospital, London, UK.
    Aggarwal, Rohit
    Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
    Agarwal, Vikas
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    COVID-19 vaccine safety during pregnancy in women with systemic lupus erythematosus2023In: Autoimmunity Reviews, ISSN 1568-9972, E-ISSN 1873-0183, Vol. 22, no 4, article id 103292Article in journal (Refereed)
    Abstract [en]

    COVID-19 vaccination has been shown to be safe in patients with systemic lupus erythematosus (SLE), but data on vaccine-associated adverse events (AEs) during the antenatal and lactation period are scarce or lacking. We investigated COVID-19 vaccination-related AEs in pregnant SLE patients from the COVAD study, a global esurvey involving 157 collaborators from 106 countries. A total of 9201 complete responses were extracted. Among 6787 (73.8%) women, we identified 70 (1.1%) who were exposed to at least one COVID-19 vaccine dose during pregnancy, 11 with SLE. Delayed onset (>7 days) vaccine-related AEs were triangulated with disease activity, treatment changes due to flare after vaccination, and COVID-19 infections in vaccinated pregnant women. Health-related quality of life and physical function was recorded using PROMIS. Age of patients ranged from 28 to 39 years; 5/11 women were of Asian origin. None of these patients reported major vaccine AEs or change in the status of their autoimmune disease. Although minor AEs were common, they did not impair daily functioning, and the symptoms resolved after a median of 3 (IQR: 2.5-5.0) days. All patients reported good to excellent health status. No adverse pregnancy outcomes were reported. Importantly, none of the patients reported thrombotic events post-vaccination, which provides reassurance in a patient population with a high risk for cardiovascular comorbidity and thrombosis, especially in the presence of antiphospholipid antibodies or the antiphospholipid syndrome, a considerable portion of SLE patients. Our findings provide reassurance and can contribute to informed decisions regarding vaccination in patients with SLE and highrisk pregnancies due to their background autoimmune disease. The risk/benefit ration of COVID-19 vaccination appears favourable, with vaccines both providing passive immunisation to the fetus and active immunisation to the mother with no signals of exacerbation of the mother's autoimmune disease.

  • 46.
    Gil-Vila, Albert
    et al.
    Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital, Medicine Dept, Universitat Autónoma de Barcelona, Barcelona, Spain.
    Naveen, R.
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
    Selva-O'Callaghan, Albert
    Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital, Medicine Dept, Universitat Autónoma de Barcelona, Barcelona, Spain.
    Sen, Parikshit
    Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, Delhi, India.
    Nune, Arvind
    Southport and Ormskirk Hospital NHS Trust, Southport, UK.
    Gaur, Prithvi Sanjeevkumar
    Smt. Kashibai Navale Medical and General Hospital, Pune, India.
    Gonzalez, Raquel Arànega
    Internal Medicine Department, Hospital Clinic, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
    Lilleker, James B.
    Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK.
    Joshi, Mrudula
    Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India.
    Agarwal, Vishwesh
    Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India.
    Kardes, Sinan
    Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, Istanbul, Turkey.
    Kim, Minchul
    Center for Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine Peoria, Illinois, US.
    Day, Jessica
    Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
    Makol, Ashima
    Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
    Milchert, Marcin
    Department of Internal Medicine, Rheumatology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland.
    Gheita, Tamer
    Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
    Salim, Babur
    Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan.
    Velikova, Tsvetelina
    Department of Clinical Immunology, Medical Faculty, University Hospital "Lozenetz", Sofia University St. Kliment Ohridski, Sofia, Bulgaria.
    Gracia-Ramos, Abraham Edgar
    Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, C.P, Mexico City, Mexico.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nikiphorou, Elena
    Centre for Rheumatic Diseases, King's College London, London, UK; Rheumatology Department, King's College Hospital, London, UK.
    Tan, Ai Lyn
    NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
    Chatterjee, Tulika
    Center for Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine Peoria, Illinois, USA.
    Cavagna, Lorenzo
    Department of Rheumatology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy; Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia, Pavia, Lombardy, Italy.
    Saavedra, Miguel A
    Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico.
    Shinjo, Samuel Katsuyuki
    Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
    Ziade, Nelly
    Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
    Knitza, Johannes
    Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
    Kuwana, Masataka
    Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
    Distler, Oliver
    Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
    Chinoy, Hector
    Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK; Department of Rheumatology, Salford Royal Hospital Northern Care Alliance NHS Foundation Trust, Salford, UK .
    Agarwal, Vikas
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
    Aggarwal, Rohit
    Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
    Gupta, Latika
    Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Dept of Rheumatology, Royal Wolverhampton Hospital NHS Trust, Wolverhampton, United Kingdom; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
    COVID-19 Vaccination In Autoimmune Diseases (COVAD) Study: Vaccine Safety In Idiopathic Inflammatory Myopathies2022In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 66, no 4, p. 426-437Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION/AIMS: We studied COVID-19 vaccination-related adverse events (ADEs) 7-days post-vaccination in patients with idiopathic inflammatory myopathies (IIMs) and other systemic autoimmune and inflammatory disorders (SAIDs).

    METHODS: 7-day vaccine ADEs were collected in an international patient self-reported e-survey. Descriptive statistics and multivariable regression were performed.

    RESULTS: 10,900 respondents [1227 IIMs; 4640 SAIDs; 5033 healthy controls (HCs), median age 42 (IQR 30-55) years, 74% female, 45% Caucasian, 69% completely vaccinated] were analysed. 76.3% IIMs patients reported minor and 4.6% major ADEs. Patients with active IIMs reported more frequent major [OR 2.7 (1.04-7.3)] and minor [OR 1.5 (1.1-2.2)] ADEs than inactive IIMs. Rashes were more frequent in IIMs [OR-2.3(1.2-4.2)] than HCs. ADEs were not impacted by steroid dose, although hydroxychloroquine and intravenous/subcutaneous immunoglobulins were associated with a higher risk of minor ADEs [OR 1.9 (1.1-3.3), OR 2.2 (1.1-4.3)]. Overall, ADEs were less frequent in inclusion body myositis (IBM) and BNT162b2 (Pfizer) vaccine recipients DISCUSSION: 7-day post-vaccination ADEs were comparable in patients with IIMs, SAIDs, and HCs, except for a higher risk of rashes in IIMs. Patients with DM, active disease may be at higher risk, and IBM patients at lower risk of specific ADEs. Overall, the benefit of preventing severe COVID-19 through vaccination likely outweighs the risk of vaccine-related ADEs Our results may inform future guidelines regarding COVID-19 vaccination in patients with SAIDs, and specifically in IIMs. Studies to evaluate long-term outcomes and disease flares are needed to shed more light on developing future COVID-19 vaccination guidelines.

  • 47.
    Gomez, A.
    et al.
    Karolinska Institutet, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden; Karolinska University Hospital, Medical Unit of Gastroenterology, Dermatology, and Rheumatology, Stockholm, Sweden.
    Jägerback, S.
    Danderyd University Hospital, Division of Rheumatology, Stockholm, Sweden.
    Sjowall, C.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping, Sweden.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden; Karolinska University Hospital, Medical Unit of Gastroenterology, Dermatology, and Rheumatology, Stockholm, Sweden; Örebro University, Department of Rheumatology, Faculty of Medicine and Health, Örebro, Sweden.
    LOW-DOSE BELIMUMAB AND ANTIMALARIAL AGENTS PREVENT RENAL FLARES IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM FOUR RANDOMISED CLINICAL TRIALS2023In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 82, no Suppl. 1, p. 1467-1468, article id AB0538Article in journal (Other academic)
    Abstract [en]

    Background: Lupus nephritis (LN) is one of the most severe manifestations in systemic lupus erythematosus (SLE), constituting a substantial cause of end-stage kidney disease, dialysis, and mortality. Prompt and adequate treatment of LN, and prevention of renal flares are key components of disease management towards improved outcomes in patients with SLE.

    Objectives: We aimed to determine the effect of the use of antimalarial agents (AMA) and different doses and pharmaceutical forms of belimumab on preventing renal flares in patients with active SLE.

    Methods: We pooled data from the BLISS-52, BLISS-76, BLISS-SC and BLISS-Northeast Asia randomised clinical trials of belimumab (N=3225), that included patients with seropositive (antinuclear antibody titres ≥1:80 and/or anti-dsDNA levels ≥30 IU/mL), active SLE yet no severe ongoing renal disease. Participants were allocated to receive intravenous (IV) belimumab 1 mg/kg (N=559), IV belimumab 10 mg/kg (N=1033), subcutaneous (SC) belimumab 200 mg (N=556) or placebo (N=1077) in addition to standard therapy. Additionally, we classified patients as AMA users if they had received hydroxychloroquine, chloroquine, mepacrine, or quinine sulphate in stable doses for at least 30 days prior to the trial commencement. The outcome of the present post-hoc analysis was development of renal flares, defined according to the analysis plan within the BLISS programme. The hazard of renal flare was assessed with Cox proportional hazards regression models, adjusted for age, sex, ethnicity, previous renal involvement, baseline proteinuria and glomerular filtration rate, and use of glucocorticoids and immunosuppressants.

    Results: In total, 192 patients developed a renal flare after a median of 197 days. In multivariable Cox regression analysis, use of AMA was associated with a lower risk of renal flares (HR: 0.64; 95% CI: 0.54–0.96; p=0.026). Compared with placebo, the risk of renal flares was lower among patients receiving IV belimumab 1 mg/kg (HR: 0.44; 95% CI: 0.25–0.79; p=0.006) and IV belimumab 10 mg/kg (HR: 0.63; 95% CI: 0.45–0.87; p=0.005), but not SC belimumab 200 mg (HR: 0.90; 95% CI: 0.57–1.42; p=0.648). When analysing all study arms with and without antimalarials separately, patients receiving IV belimumab 1 mg/kg along with AMA experienced the lowest rate of renal flares (18.5 (7.4–38.1) cases per 1000 person-years). Using patients who received placebo but not AMA as the reference comparator, patients receiving IV belimumab 1 mg/kg (OR: 0.30; 95% CI: 0.13–0.70; p=0.005) and patients receiving IV belimumab 10 mg (OR: 0.45; 95% CI: 0.27–0.75; p=0.002) were protected against renal flares only when belimumab use was combined with AMA.

    Conclusion: In this RCT setting, belimumab and AMA protected against renal flares in patients with active seropositive SLE yet no ongoing severe renal involvement. The protective effect of IV belimumab against renal flares appeared optimal when belimumab was combined with AMA. The prominent effect of low-dose belimumab motivates investigation of the efficacy of intermediate doses of belimumab.

  • 48.
    Gomez, A.
    et al.
    Karolinska Institutet and Karolinska University Hospital, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet and Karolinska University Hospital, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden; Örebro University, Department of Rheumatology, Faculty of Medicine and Health, Örebro, Sweden.
    Sjöwall, C.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping, Sweden.
    OBESITY AND TOBACCO SMOKING ARE INDEPENDENTLY ASSOCIATED WITH POOR PATIENT-REPORTED OUTCOMES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS FROM A SWEDISH TERTIARY REFERRAL CENTRE2022In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 81, no Suppl. 1, p. 1402-1402, article id AB0549Article in journal (Other academic)
  • 49.
    Gomez, Alvaro
    et al.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Enman, Yvonne
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Impact of Belimumab on Patient-Reported Outcomes in Systemic Lupus Erythematosus: Insights from Clinical Trials and Real-World Evidence2023In: Patient Related Outcome Measures, E-ISSN 1179-271X, Vol. 14, p. 1-13Article, review/survey (Refereed)
    Abstract [en]

    Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease, characterised by a relapsing-remitting pattern of inflammatory activity, with each relapse contributing to irreversible end-organ damage with detrimental effects on patients' course, adding up to morbidity burden and shortening life-length. Along with several other demographic, socioeconomic, and life-style factors, high inflammatory activity and accrued organ damage have been coupled with adverse health-related quality of life (HRQoL) within physical, mental, and psychosocial aspects. The management of SLE has improved substantially during the last decades, owing to a technological explosion that has advanced drug development towards more targeted options. Being the first drug to be approved for SLE in more than half a century and the first in history biological agent for SLE, the introduction in 2011 of the monoclonal antibody belimumab that specifically binds to the soluble counterpart of B cell activating factor (BAFF) was a breakthrough in SLE drug development. The efficacy and favourable safety profile of belimumab has been demonstrated across several clinical trials and observational studies. Herein, we reviewed the literature and provide a summary on the effects of belimumab on SLE patients' HRQoL based on 23 studies. Belimumab has been shown to induce clinically important improvements in physical aspects of HRQoL and in fatigue, the latter being a common and major complaint within the SLE population. People with SLE overall benefit more from belimumab within physical compared with mental aspects of HRQoL. However, despite improvements of clinical and immunological features upon therapy with belimumab, HRQoL perception remains unsatisfactory for a substantial percentage of the patients. Finally, our review made apparent an urgent need for optimisation of the use of patient-reported outcome measures, both in research and clinical practice.

  • 50.
    Gomez, Alvaro
    et al.
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Medical Unit of Gastroenterology, Dermatology, and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Jägerback, Sandra
    Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Division of Rheumatology, Danderyd University Hospital, Stockholm, Sweden.
    Sjöwall, Christopher
    Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden.
    Parodis, Ioannis
    Örebro University, School of Medical Sciences. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Medical Unit of Gastroenterology, Dermatology, and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Belimumab and antimalarials combined against renal flares in patients treated for extra-renal systemic lupus erythematosus: results from 4 phase III clinical trials2023In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, article id kead253Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine the effect of antimalarial agents (AMA) and different doses and pharmaceutical forms of belimumab on preventing renal flares in patients with systemic lupus erythematosus (SLE) treated for extra-renal disease.

    METHODS: We pooled data from the BLISS-52, BLISS-76, BLISS-SC and BLISS-Northeast Asia trials of belimumab (N = 3225), that included patients with active SLE yet no severe ongoing nephritis. Participants were allocated to receive intravenous belimumab 1 mg/kg, intravenous belimumab 10 mg/kg, subcutaneous belimumab 200 mg, or placebo in addition to standard therapy. We estimated hazards of renal flare development throughout the study follow-up (52-76 weeks) using Cox regression analysis.

    RESULTS: In total, 192 patients developed a renal flare after a median of 197 days. Compared with placebo, the risk of renal flares was lower among patients receiving intravenous belimumab 10 mg/kg (HR: 0.62; 95% CI: 0.41-0.92; p = 0.018) and intravenous belimumab 1 mg/kg (HR: 0.42; 95% CI: 0.22-0.79; p = 0.007), while no significant association was found for subcutaneous belimumab 200 mg. AMA use yielded a lower hazard of renal flares (HR: 0.66; 95% CI: 0.55-0.78; p < 0.001). The protection conferred was enhanced when belimumab and AMA were co-administered; the lowest flare rate was observed for the combination intravenous belimumab 1 mg/kg and AMA (18.5 cases per 1000 person-years).

    CONCLUSIONS: The protection conferred from belimumab against renal flare development in patients treated for extra-renal SLE appears enhanced when belimumab is administered along with AMA. The prominent effect of low-dose belimumab warrants investigation of the efficacy of intermediate doses.

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